摘要
目的应用三维纵向应变成像技术评估常规超声心动图检查未发现室壁运动异常的可疑冠状动脉粥样硬化性心脏病（以下简称冠心病）患者是否存在冠状动脉的严重病变。方法选取疑似冠心病患者102例,按冠状动脉造影结果分为对照组32例（冠状动脉主干及所有分支狭窄均〈50%）、低危组28例（右冠状动脉主干、左回旋支中1-2支狭窄≥70%）及高危组42例（左冠状动脉主干狭窄≥50%或左前降支狭窄≥70%）。行常规超声心动图检查后再应用三维纵向应变成像测量各组左室整体纵向峰值应变（GLPS）,并比较其差异;绘制受试者工作特征（ROC）曲线获得GLPS预测冠心病高危因素的合适界值。结果各组常规超声心动图检查参数舒张末期容积指数（EDVI）、收缩末期容积指数（ESVI）、左室射血分数（LVEF）、二尖瓣口血流频谱E峰速度（E）、二尖瓣口血流频谱A峰速度（A）及二尖瓣环运动舒张晚期速度（Aa）比较,差异均无统计学意义;低危组和高危组的E/A、二尖瓣环运动舒张早期速度（Ea）及Ea/Aa与对照组比较,差异均有统计学意义（均P〈0.05）。低危组GLPS值为（-17.98±1.99）%,高危组GLPS值为（-16.01±2.77）%,与对照组[（-19.32±2.32）%]比较,差异均有统计学意义（均P〈0.05）;高危组GLPS值较低危组明显减低,差异有统计学意义（P〈0.05）。通过ROC曲线分析GLPS预测冠心病高危因素的合适界值为-17.9%,敏感性为78.1%,特异性为73.7%。结论常规超声心动图检查无室壁运动异常的高危冠心病患者GLPS减低,其可以帮助早期发现是否存在这种高危因素。
Objective To predict the presence of severe stenosis in the coronary artery by using 3-dimensional strain imaging in coronary artery disease（CAD）patients without wall motion abnormality by conventional echocardiography. Methods One hundred and two patients were enrolled in this study,all subjects underwent coronary angiography,patients with normal or minimal coronary stenosis（〈50%）were served as control group（32 cases）,patients with stenosis in 1-or 2 major vessel（RCA or LCX）≥70% were served as low-risk group（28 cases）,and others with severe coronary stenosis were served as high-risk group（42 cases）.Left ventricular global peak strain,longitudinal strain（GLPS）were measured by 3-dimensional strain imaging. Receiver-operating characteristic（ROC） curve was drawn to obtain the optimal cut-off value for predicting high-risk with GLPS. Results The conventional echocardiographic parameters of EDVI,ESVI,LVEF,E,A and Aa values had no significant differences between each group.Compared with the control group, the differences of the E/A,Ea and Ea/Aa in the low-risk group and high-risk group were statistically significant（all P〈0.05）.The GLPS of the low-risk group and the high-risk group were（-17.98±1.99）% and（-16.01±2.77）%,there were significantly reduced both in low-risk and high-risk groups compared with the control group[（-19.32 ±2.32）%]（all P〈0.05）.Compared with low-risk group,GLPS was statistically reduced in high-risk group（P〈0.05）.Results from ROC curve analysis showed the optimal cut-off value of GLPS for predicting high risk was-17.9%,the sensitivity was 78.1% and the specificity was 73.7%. Conclusion GLPS is reduced in high-risk CAD without wall motion abnormality detected by conventional echocardiography,and GLPS can help to identify the presence of such severe disease early.
出处
《临床超声医学杂志》
2016年第11期730-733,共4页
Journal of Clinical Ultrasound in Medicine
基金
湖北省十堰市科技局指导项目(15Y28)
