速度向量成像技术对冠心病左心室生物力学参数的检测及其在冠状动脉狭窄评估中的应用

目的：应用速度向量成像（VVI）技术检测冠心病（CAD）患者的心肌生物力学参数，评估冠状动脉狭窄程度。方法：将52例经冠状动脉造影检查（CAG）显示至少有一支冠状动脉狭窄的患者分为轻度狭窄组（21例，冠脉狭窄程度均＜75%）和重度狭窄组（31例，至少一支冠状动脉狭窄程度≥75%)，选择同期冠脉造影显示无冠脉狭窄正常人20名作为正常对照组，应用VVI检测左室壁整体纵向应变（GLS）、整体圆周应变（GCS）和整体径向应变（GRS），分析
冠状动脉狭窄心肌生物力学参数改变。结果：冠脉轻度狭窄组和重度狭窄组患者GLS、GRS、GCS的绝对值均较正常对照组下降（P<0.05），且重度狭窄组整体应变参数下降更显著，与轻度狭窄组比较差异有统计学意义（P<0.05）；纵向应变明显下降节段的分布大体与冠脉造影显示狭窄率≥75%的病变冠脉的心肌灌注区域一致，以GLS的敏感性最高，正常对照组、冠脉轻度狭窄组和重度狭窄组GLS与左室射血分数（LVEF）呈负相关关系（r=－0.
58、－0.51和－0.43，P<0.05）。若以GLS为－16.14%作为截断点评估冠脉重度狭窄并需要施行PTCA治疗的灵敏度为96.8%，特异度为70%；Yuedden指数最高，为0.668。结论：VVI可检出冠心病患者左室应变明显下降，提示冠状动脉出现严重狭窄；可根据应变明显下降节段的分布
推测相应冠脉严重狭窄。
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Determinationofleftventricularbiomechanicalparametersbyusing velocity vector imaging technology and its application in assessing coronary artery stenosis in coronary artery disease

Objective To determine the biomechanical parameters of left ventricular by using velocity vector imaging(VVI),and to indirectly assess the coronary artery stenosis with VVI in the patients with coronary artery disease(CAD).Methods 52 patients who had one coronary artery lesions at least diagnosed by coronary angiography(CAG)were divided into coronary artery mild stenosis group and severe stenosis group;21patients in mild stenosis group had one coronary stenosis <75%;31patients in severe stenosis group had one coronary artery stenosis ≥75% at least.At the same time,20 cases of normal people without coronary artery stenosis showed by CAG were selected as normal control group.VVI was used to detect the left ventricular wall segments of the overall longitudinal strain(GLS),the overall circumferential strain(GCS)and the overall radial strain(GRS).Results The absolute values of GLS,GRS,GCS of the patients in mild and severe coronary artery stenosis groups were significantly decreased than those in normal control group(P<0.05),and the strain parameters in severe stenosis group were decreased more significantly,there were significant differences compared mild stenosis group(P<0.05).The distribution of the segments with decreased longitudinal strain matched the LV myocardial segment with the coronary stenosis rate ≥ 75%,and GLS had the most sensitivity.The GLS in normal control group,mild stenosis group and severe stenosis group were negatively correlated to left ventricular ejection fraction(LVEF)(r=-0.58,P<0.05;r=-0.51,P<0.05;r=-0.43,P<0.05).GLS-16.14 % was used to assess the severe coronary artery stenosis with requiring the implementation of PTCA treatment as the diagnostic cut-off point with sensitivity 96.8%,specificity of 70%,the highest Yuedden index 0.668.Conclusion The decreasing of left ventricular strain could be detected by VVI,which suggests that severe coronary artery stenosis exists in coronary artery;the distribution of the segments with significantly decreased strains can be used to assess the coronary lesions and stenosis degrees.