三维斑点追踪成像技术对冠心病患者狭窄冠脉灌注区域局部应变的评价

目的 结合冠状动脉所属区域各项应变参数,分析冠状动脉狭窄对该局部区域应变的影响.方法 入选2012年5～11月我院行冠脉造影检查的拟诊或确诊冠心病51例,其中男性36例,女性15例,年龄40～70(56.01 ±8.55)岁.将所有人选者按三支冠脉分布区分为左前降支灌注区、左回旋支灌注区及右冠状动脉灌注区,共153个区域;按冠脉造影狭窄是否＞50％将各区域分组,共分为6组:左前降支狭窄≥50％组(25个)、左前降支狭窄＜50％组(26个)、回旋支狭窄≥50％组(23个)、回旋支狭窄＜50％组(28个)、右冠狭窄≥50％组(29个)和右冠狭窄＜50％组(22个).所有入选者采集标准心尖四腔切面左心室全容积图像并存储,应用3DST在线分析软件获得各应变参数.将各冠脉灌注区域内各项应变等参数分别求和计算均数.分析冠心病左室局部应变等参数.结果 ①左前降支狭窄＜50％组与狭窄≥50％组的左前降支灌注区域各项应变平均值分别为:纵向峰值应变-16.17±5.26比-13.03±4.84,P＜0.01;周向峰值应变-31.79±14.10比-24.74±9.12,P＜0.01;径向峰值应变32.02±14.64比27.70±10.48,P＜0.05;心内膜面积应变-41.42±14.87比-33.54±11.74,P＜0.01.②回旋支狭窄＜50％组与狭窄≥50％组的回旋支灌注区域各项应变均值分别为:纵向峰值应变-14.95±6.01比-12.04±4.25,P＜0.05;周向峰值应变-28.46±15.09比-24.23±10.22,P＜0.05;径向峰值应变31.81±14.45比26.59±12.45,P＜0.05;心内膜面积应变-37.15±13.83比-30.47±12.29,P＜0.05.③右冠状动脉狭窄＜50％组与狭窄≥50％组的右冠状动脉灌注区域各项应变均值分别为:纵向峰值应变-14.23±5.01比-12.09±4.67,P＞0.05;周向峰值应变-28.47±11.95比-23.50±10.22,P＜0.05;径向峰值应变30.22±15.86比26.32±7.93,P＞0.05;心内膜面积应变-39.40±14.23比-30.29±10.84,P＜0.05.④冠脉分布区局部心内膜面积峰值应变对该区域灌注血管狭窄的诊断价值较高.结论 ①三维斑点追踪成像技术通过多项应变参数可以发现冠心病患者早期缺血时心肌形变能力的减低.②左室局部周向、纵向应变可用于冠心病患者心肌缺血的检测,但诊断价值较低.③局部心内膜面积峰值应变对早期心肌缺血有较好的诊断价值.

Three-dimensional speckle tracking imaging in evaluating local strain of stenosis Coronary perfusion area in patients with coronary heart disease

Three-dimensional speckle tracking imaging in evaluating local strain of stenosis Coronary perfusion area in patients with coronary heart disease Objective: Combined coronary respective districts contingency parameter analysis of coronary artery stenosis and the local area strain. Methods: 51 patients (36 males and 15 females) undergone coronary angiography were enrolled in the study. Aged 40 to 70 years, average of (56.01 ± 8.55) years old. Exclusion criteria: myocardial infarction, cardiomyopathy, congenital heart disease, severe valve disease, hypertension with ventricular hypertrophy, diabetes. Every left ventricular was divided into three perfusion areas including anterior descending (LAD) artery perfusion area, circumflex artery (LCX) perfusion area and right coronary artery (RCA) perfusion area. Those areas were divided into six groups according to whether coronary stenosis was less than 50%: anterior descending artery control group (26); left anterior descending artery stenosis group (25); circumflex artery control group (28); circumflex artery stenosis group (23); right coronary control group (22); right coronary stenosis group (29). Standard apical four-chamber view of left ventricular volume images were collected and stored for all selected patients. And 3DST online analysis software was used to obtain each strain parameters. The means of those parameters about the perfusion areas were calculated. The local strain parameters in patients with coronary heart disease were analyzed. Results: 1. LS of the control and stenosis group of LAD perfusion area: -16.17± 5.26vs-13.03±4.84 (p<0.01), CS: -31.79±14.10vs 24.74±9.12 (p<0.01), RS: 32.02 ± 14.64vs27.70±10.48 (p<0.05), AT: -41.42±14.87vs 33.54±11.74 (p<0.01). 2. LS of the control and stenosis group of LCX perfusion area: -14.95±6.01vs12.04±4.25 (p<0.05), CS: -28.46±15.09vs-24.23±10.22 (p<0.05), RS: ±14.45vs26.59±12.45 31.81 (p<0.05), AT: -37.15±13.83vs 30.47±12.29 (p<0.05). 3. LS of the control and stenosis group of RCA perfusion area: -14.23±5.01vs 12.09±4.67 (p>0.05), CS: -28.47±11.95vs-23.50±10.22 (p<0.05), RS: 30.22±15.86vs26.32±7.93 (p>0.05), AT: -39.40±14.23vs-30.29±10.84 (p<0.05). 4. Local AT has higher diagnostic value of its perfusion areas coronary vascular stenosis. Conclusion: 1. Using three-dimensional speckle tracking imaging can find deformation ability reduced in early stage of myocardial ischemia through the reduced deformation capacity. 2. LS, CS can be used for the detection of myocardial ischemia in patients with coronary heart disease, but the diagnosis values were low. 3. AT had better diagnostic value of early myocardial ischemia.