摘要
目的探讨采用超声心肌做功技术评价左前降支(LAD)狭窄患者左心室收缩功能,及各参数对LAD狭窄的诊断效能。资料与方法前瞻性收集2019年10月—2021年3月哈尔滨医科大学附属第四医院疑似诊断为冠心病并拟行冠状动脉造影的患者249例,于冠状动脉造影前3 d内行超声心动图检查,根据冠状动脉造影LAD狭窄程度,分为对照组(无狭窄)、轻度组(0<狭窄程度≤50%)、中度组(50%<狭窄程度<75%)和重度组(狭窄程度≥75%),每组均筛选30例符合超声检查入选标准、无器质性病变及其他检查禁忌证的患者纳入研究,分析临床资料,常规超声参数,左心室整体纵向应变,心肌做功参数包括整体做功指数、整体有效功、整体做功效率(GWE)和整体无效功,采用受试者工作特征曲线分析各参数对LAD中、重度狭窄的诊断价值。结果4组患者性别、年龄、高血压及糖尿病患病情况、接受药物治疗情况和常规超声参数左心房内径、左心室舒张末期内径和容积、收缩末期内径和容积、左心室射血分数、舒张期二尖瓣口流速、E/e'差异均无统计学意义(P均>0.05)。4组整体纵向应变、整体做功指数、整体有效功、GWE、整体无效功比较,差异均有统计学意义(F=24.137、33.223、29.343、135.819、37.730,P均<0.05);与对照组比较,中度组(t=4.678、5.405、4.941、9.639、−5.753)和重度组(t=7.876、8.960、8.728、17.992、−9.734)差异均有统计学意义(P均<0.05);与轻度组比较,中度组(t=3.029、4.105、3.142、7.871、−3.994)和重度组(t=6.227、7.660、6.929、16.225、−7.975)差异均有统计学意义(P均<0.05);重度组与中度组比较,差异均有统计学意义(t=3.198、3.555、3.788、8.353、−3.981,P均<0.05)。预测LAD中度和重度狭窄均以GWE诊断价值最高,GWE诊断LAD中度狭窄的曲线下面积为0.919,最佳截断值为97.5%,敏感度、特异度分别为93.3%、71.7%;GWE诊断LAD重度狭窄的曲线下面积
Purpose To evaluate left ventricular systolic function in patients with left anterior descending(LAD)branch stenosis via ultrasound myocardial work,and to evaluate the diagnostic efficacy of each parameter in LAD branch stenosis.Materials and Methods A total of 249 patients who were admitted to the Fourth Affiliated Hospital of Harbin Medical University from October 2019 to March 2021 and were suspected to be diagnosed with coronary heart disease and expected to undergo coronary angiography were prospectively collected.Echocardiography was performed within 3 days prior to coronary angiography.They were divided into control group(no stenosis),mild group(0<stenosis≤50%),moderate group(50%<stenosis<75%)and severe group(stenosis≥75%)according to the degree of LAD stenosis.A total of 30 patients in each group who met the inclusion criteria of ultrasound examination and had no organic lesions or other contraindications were screened to be included in the study.The differences of clinical data,conventional ultrasound parameters,global longitudinal strain of left ventricle and myocardial work parameters including global work index,global effective work,global work efficiency(GWE)and global ineffective work were analyzed.The value of each parameter in the diagnosis of moderate and severe stenosis of left anterior descending branch were analyzed via receiver operating characteristic curve.Results There were no significant differences in clinical data of 4 groups in gender,age,prevalence of hypertension and diabetes,drug treatment and conventional ultrasound parameters including left atrial diameter,left ventricular end-diastolic internal diameter and volume,left ventricular end-systolic internal diameter and volume,left ventricular ejection fraction,diastolic mitral orifice flow rate and E/e'(all P>0.05).There were statistically significant differences in global longitudinal strain,global work index,global effective work,GWE and global ineffective work among the 4 groups(F=24.137,33.223,29.343,135.819,37.730;all P<0.05
作者
王岩
鲁洪涛
尹璐瑶
邵亭亭
王超
薛莉
WANG Yan;LU Hongtao;YIN Luyao;SHAO Tingting;WANG Chao;XUE Li(Department of Cardiovascular Ultrasound,the Fourth Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中国医学影像学杂志》
CSCD
北大核心
2023年第4期349-355,共7页
Chinese Journal of Medical Imaging
基金
国家自然科学基金面上项目(81571690)
哈尔滨医科大学附属第四医院特别资助项目(HYDSYTB202102,HYDSYTB202226)。
