摘要
目的比较定量组织速度成像（QTVI）技术与应变率成像（SRI）技术在大剂量多巴酚丁胺负荷试验（DSE）中诊断心肌缺血的应用价值。方法49例疑诊冠心病患者，分别于静息、10、20、30、40μg·kg^-1·min^-1多巴酚丁胺负荷下获取心尖两腔、四腔观清晰组织速度成像图。脱机分析侧壁、室间隔、前壁、下壁心肌基底段、中段心内膜下心肌QTVI与SRI曲线，QTVI测量参数为收缩期峰值运动速度（VS）和舒张早期峰值运动速度（VE），SRI测量参数为收缩期峰值应变率（SRSYS）和最大应变（εMAX）。结果根据常规HDDSE与冠状动脉造影结果，将冠心病组患者心肌节段区分为正常节段与缺血节段（缺血组）；与对照组正常节段（正常组）比较，静息状态下，缺血组与正常组节段间VS、VE、SRSYS、εMAX差异无统计学意义；峰值负荷时，与正常组各节段比较，缺血组各节段VS、VE、SRSYS、εMAX明显减低（P〈0．05）。以选择性冠状动脉造影为诊断冠心病的金标准，将峰值负荷下基底段心肌VS≤9．6cm／s，中段心肌VS≤8．3cm／s，SRSYS≤-2．6S^-1为诊断冠状动脉狭窄的截断值，DSE中QTVI诊断心肌缺血的敏感性、特异性分别为80．8％、80．4％；DSE中SRI诊断心肌缺血的敏感性、特异性分别为83．6％、85．7％。与QTVI比较，DSE中SRI诊断心肌缺血的敏感性与特异性显著增高（P〈0．01）。结论DSE中QTVI与SRI技术均能准确、无创检测冠心病缺血心肌，SRI技术敏感性、特异性更直高。
Objective To compare the value to detect myocardial ischemia in patients with coronary artery disease （CAD） by quantitative tissue velocity imaging（QTVI） and strain rate imaging （SRI） in high dose dobutamine stress echocardiography （DSE）. Methods DSE were performed in 49 patients with suspected CAD. Tissue velocity imaging at baseline, 10,20,30,40μg·kg^-1·min^-1 dobutamine in 2-chamber, 4-chamber apical views were obtained for analysis off-line and QTVI or SRI curves of endomyocardium at basal and middle segments of laterior, septal, anterior and inferior wall were analyzed. QTVI indices included peak velocity in systolic （VS） and peak velocity in early diastolic （VE）. SRI indices included peak strain rate in systolic （SRSYS） and peak strain in systolic （εMAX）. Results Segments of patients with CAD were divided into normal and ischemic segments by conventional DSE and selected coronary angiography （SCA）. At baseline, there was no significant difference of VS,VE,SRSYS,εMAX between the normal segments of normal controls （normal, Group N） and ischemic segments of patients with CAD （abnormal, Group A）. At peak stress, compared with Group N, Group A had significantly decreased VS,VE,SRSYS,εMAX and CMAX （ P 〈 0.05）. Taking SCA as the golden standard of diagnosing CAD,assuming VS≤9. 6 cm/s in basal segments and VS≤8.3 cm/s in middle segments or SRSYS≤-2.6 s^-1 as the cut-off point,the sensitivity,specificity of QTVI or SRI combined with DSE were 80.8% ,80.4% and 83.6%, 85.7% ,respectively. Comparing with QTVI,SRI combined with DSE had higher sensitivity and specificity （ P 〈 0. 01）. Conclusions In DSE, both QTVI and SRI can detect myocardial ischemia invasively and accurately. However,SRI has higher sensitivity and specificity than QTVI.
出处
《中华超声影像学杂志》
CSCD
2007年第2期108-111,共4页
Chinese Journal of Ultrasonography
基金
湖北省科技厅资助项目（2003AA301C02）
