三维斑点追踪技术判断冠状动脉左前降支重度狭窄的价值

目的探讨三维斑点追踪(3DT)技术参数判断冠心病(CHD)患者冠状动脉左前降支(LAD)重度狭窄的价值。方法将58例CHD患者根据冠状动脉造影(CAG)结果分为两组,A组(LAD狭窄率<75%)21例,B组(LAD狭窄率≥75%)37例。经胸心尖四腔观采集左心室三维全容积动态图像,运用4D Auto LVQ软件进行在线分析,比较LAD供血节段收缩期三维整体纵向应变(LAD-GLS)、圆周应变(LAD-GCS)、面积应变(LAD-GAS)、径向应变(LAD-GRS)参数的差异。以CAG结果作为金标准,分别计算LAD-GLS、LAD-GCS、LAD-GAS、LAD-GRS判断LAD重度狭窄的最佳截断值、敏感性、特异性及ROC曲线下面积(AUC)。结果 B组LAD-GLS、LAD-GCS、LAD-GAS、LAD-GRS较A组明显减低,差异有统计学意义(均P<0.01);检测LAD重度狭窄的最佳截断值、敏感性、特异性及AUC分别为LAD-GLS:18.20%、93.80%、60.00%、0.86,LAD-GCS:14.75%、53.10%、95.00%、0.72,LAD-GAS:25.50%、56.30%、95.00%、0.79,LAD-GRS:39.95%、53.10%、95.00%、0.79。结论 3DT参数可用来判断CHD患者LAD重度狭窄,LAD-GLS敏感性高,但特异性低;LAD-GCS、LAD-GAS及LAD-GRS特异性高,但敏感性低。

Value of Three-dimensional Speclde Tracking Parameters for Judging severe Stenosis of left Anterior Descending Coronary Artery.

Objeelive To explore the value of three-dimensional speckle tracking（3DT） parameters for judging severe stenosis of left anterior descending coronary artery （LAD） of patients with coronary heart disease（CHD）. Methods 58 patients with CHD were divid- ed into two groups according to the coronary artery angiography （CAG） results. There were 21 cases in Group A （LAD stenosis rate 〈 75 % ）, and 37 cases in Group B （LAD stenosis rate≥ 75 % ）. The three-dimensional fttll volume dynamic image of Left ventricular was collected at the apical four-chamber view by chest, then the strain parameters, including systolic three-dimensional global longi- tudinal, circumferential, area and radial strains in LAD blood supplying segments（LAD-GLS, LAD-GCS,LAD-GAS, LAD-GRS）were obtained online by 4D Auto LVQ software. Values of these parameters between two groups were compared. Taking CAG results as the gold standard, the best cut-off value, sensitivity, specificity and areas under the ROC curve （AUC） of judging LAD severe stenosis with LAD-GLS, LAD-GCS, LAD-GAS and LAD-GRS were calculated, respectively. Results Group B had lower LAD-GLS, LAD- GCS,LAD-GAS and LAD-GRS than group A （ P 〈 0.01） significantly; Detection LAD severe stenosis of the best cut-off value, sen- sitivity, specificity and AUC were： LAD-GLS-18.20%, 93.80%, 60.00%, 0.86; LAD-GCS-14.75%, 53.10%, 95.00%, 0.72; LAD-GAS-25.50%, 56.30%, 95.00%, 0.79; LAD-GRS 39.95%, 53.10%, 95.00%, 0.79 respectively. Conclusions The strain parameters measured by 3I）T can be used to judge severe stenosis of LAD in patients with CHD. LAD-GLS had high sensi- tivity, but low specificity; LAD-GCS, LAD-GAS and LAD-GRS had high specificity, but low sensitivity.