三维斑点追踪技术对冠心病左室收缩功能的研究

目的 应用三维斑点追踪技术(3D-STI)评价冠心病患者左室各节段及整体收缩功能。方法50例超声心动图显示未见明显节段性室壁运动异常但行冠脉造影（CAG）检查确诊CHD者为实验组，同时以30例高度怀疑冠心病（CHD），但二维超声心动图及冠脉造影均未见异常者为对照组。利用3D-STI技术、M型Teichholz法和二维双平面Simpson法测量两组患者的左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）。应用3D-STI技术软件得出应变参数((左室收缩期峰值环向应变(LS)、左室收缩期峰值圆周应变(CS)、左室收缩期峰值径向应变(RS)及左室收缩期峰值面积应变(AS))、左心室17节段的时间-应变曲线及显示左心室各节段应变的牛眼图；以CAG结果为金标准，对比三种方法得到的各参数与CAG结果的相关性。结果 对照组三种方法所得心功能参数（LVEDV、LVESV、LVEF）比较，差异均无统计学意义（P＞0.05）。实验组三种方法所得心功能参数（LVEDV、LVESV、LVEF）比较，差异均有统计学意义（P＜0.05）。3D-STI法所得实验组不同病变冠脉分支不同节段之间心功能参数（LS、CS、RS、AS）比较，差异均有统计学意义（P＜0.05）。两组间3D-STI各应变参数（GLS、GCS、GRS、GAS）比较，差异均有统计学意义（P＜0.05）。ROC曲线表明GLS、GAS为诊断冠心病的最佳敏感指标。结论3D-STI能更好的评估冠心病节段病变及整体左室收缩功能，为临床在冠心病的及时诊断提供帮助。

Three dimensional speckle tracking technique for left ventricular systolic function in patients with coronary heart disease

Objective To evaluate the left ventricular segment and overall systolic function in patients with coronary heart disease using three-dimensional speckle tracking imaging (3D-STI).Methods In 50 cases of echocardiography showed no obvious segmental wall motion abnormalities but coronary angiography (CAG) diagnosed CHD patients as the experimental group, while 30 cases of 30 cases of suspected coronary heart disease (CHD), but the two-dimensional echocardiography and coronary angiography were normal as control group. The left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by 3D-STI, M, Teichholz and two-dimensional biplane Simpson methods in two groups. Strain parameters obtained with 3D-STI software ((left ventricular peak systolic circumferential strain (LS), left ventricular peak systolic circumferential strain (CS), left ventricular peak systolic radial strain (RS) and left ventricular systolic peak area strain (AS)), bovine map strain curve of left ventricular segment and time - 17 left ventricular strain; CAG results as the gold standard, the correlation parameters and CAG results are compared with the three methods.Results The cardiac function parameters (LVEDV, LVESV, LVEF) of the three groups in the control group were not statistically significant (P > 0.05). The cardiac function parameters (LVEDV, LVESV, LVEF) of the three methods in the experimental group were compared, the difference was statistically significant (P < 0.05). The cardiac function parameters (LS, CS, RS, AS) between the different segments of coronary artery in the experimental group were statistically different (P < 0.05) by 3D-STI method. The difference of 3D-STI parameters between the two groups (GLS, GCS, GRS, GAS) was statistically significant (P < 0.05).Conclusion 3D-STI can better assess coronary artery disease, segmental lesion and whole left ventricular systolic function, which can help the clinical diagnosis of cad.