二维超声斑点追踪成像评价室壁运动正常冠心病多支病变患者左室收缩功能

目的:探讨二维超声斑点追踪成像技术(2D-STI)定量分析室壁运动正常冠心病多支病变(NWM-MVD)患者左室收缩功能的临床应用价值。方法:随机选取NWM-MVD患者45例、对照组36例。采集左室短轴观及心尖位长轴观动态灰阶图像,运用Q-analysis软件测量左室各节段收缩期峰值应变、左室整体长轴应变(GLS),并计算左室整体环向应变(GCS)、径向应变(GRS)及左室基底段、中间段、心尖段纵向应变(Bas-GLS、Mid-GLS、Ap-GLS)、环向应变(Bas-GCS、Mid-GCS、Ap-GCS)、径向应变(Bas-GRS、Mid-GRS、Ap-GRS)。结果:①冠脉阻塞或次全阻塞的NWM-MVD患者中85.71%有冠脉造影可显示的侧支形成;②NWM-MVD患者心率较对照组显著减慢[(61.78±6.76)次/min比(66.13±6.24)次/min,P<0.01),常规超声测量指标与对照组比较均无显著差异(P>0.05)。③NWM-MVD组GLS、Bas-GLS、Mid-GLS、Bas-GCS、Mid-GCS、GRS、Bas-GRS较对照组显著减低(P<0.05)。结论:NWM-MVD患者纵向、环向、径向收缩功能均存在不同程度的受损,以基底段心肌及心肌纵向收缩功能受损明显。

Assessment of Left Ventricular Systolic Function in Multi-Vessel Coronary Artery Disease Patients with Normal Wall Motion by Speckle Tracking Imaging

Objective: To evaluate the myocardial systolic function in multi-vessel coronary artery disease patients with normal wall motion(NWM-MVD) by two dimensional speckle tracking imaging.Methods: Forty-five NWM-MVD patients and thirty-six subjects with low risk of coronary artery disease(control group) were enrolled into this study.The two-dimensional loop-cine was obtained in apical long axis views and three levels of short axis views of left ventricle.Left ventricular wall was divided into 18 segments by Q-analysis software,and longitudinal,radial,circumferential systolic strain and global longitudinal strain(GLS) were analyzed.We calculated the average of radial and circumferential systolic strain of 18 segments as global radial and circumferential strain(GRS and GCS),and the average of longitudinal,radial and circumferential systolic strain of basic(Bas-GLS,Bas-GCS,Bas-GRS),middle(Mid-GLS,Mid-GCS,Mid-GRS) and apex systolic strain(Ap-GLS,Ap-GCS,Ap-GRS).Results: ① Coronary collaterals were visible in 85.71% coronary total or almost total occlusion NWM-MVD patients.② Bradycardia was more common in NWM-MVD group than that in control group(16/45 vs.5/36,P < 0.05).The conventional echocardiography parameters of left ventricular systolic and diastolic function were similar between NWM-MVD and control groups.③ Compared with that respectively in control group,GLS,GRS,Bas-GLS,BasGCS,Bas-GRS,Mid-GLS,and Mid-GCS were decreased in NWM-MVD group(P < 0.05).Conclusion: Myocardial systolic function was impaired in MVD patients,especially for basal systolic function, and longitudinal systolic function,though they had normal wall motion at rest.