心脏超声斑点成像技术对冠状...硬化性心脏病的诊断价值分析_陈春强.pdf

doi:1011659/jjssx07E022093临床研究心脏超声斑点成像技术对冠状动脉粥样硬化性心脏病的诊断价值分析陈春强1，王燕1，郭雷1，江昆2(1 聊城市第二人民医院/山东第一医科大学附属聊城二院心脏超声科，山东 聊城252600;2 聊城市第二人民医院/山东第一医科大学附属聊城二院心外科，山东 聊城 252600)摘要 目的探讨三维超声斑点追踪成像技术(3D-STI)对冠状动脉粥样硬化性心脏病(CHD)的诊断价值。方法选取我院疑似 CHD 的患者 128 例，患者均采用三维超声心动图进行检查，获取心脏的三维全容积动态图，并以 3D-STI 对心脏三维全容积动态图进行分析。根据冠状动脉造影的检查结果将患者分成正常组、轻度组、中度组及重度组，比较各组患者的年龄、性别、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、舒张期室间隔厚度(IVST)、左心室心肌质量(LVmass)、左心室射血分数(LVEF)及三维 LVEF(3D-LVEF)，测量各组患者左心室整体长轴收缩期峰值应变(GLS)、左心室整体圆周收缩期峰值应变(GCS)、左心室整体径向收缩期峰值应变(GS)、左心室整体面积收缩期峰值应变(GAS)、GAS 变化率(GAS rate)及三维左心室整体应变(3D-Strain)，并分析 3D-STI 各参数对 CHD 的诊断价值。结果128 例患者中，27 例冠状动脉正常(正常组)、32 例冠状动脉轻度狭窄(轻度组)、37 例冠状动脉中度狭窄(中度组)、32 例冠状动脉重度狭窄(重度组)。重度组患者的 LVEDD 显著大于其他 3 组(P 0 05)，LVEF和3D-LVEF显著低于其他 3 组(P 0 05)，LVmass显著大于轻度组和正常组(P 0 05)。各组患者 GAS rate 比较，差异无统计学意义(P 0 05)。重度组患者的各项 3D-STI 参数明显低于其他 3 组(P 0 05);中度组患者的 GS、GLS、GAS、GCS 及 3D-Strain 均低于正常组和轻度组(P 0 05)。以冠状动脉造影检查结果作为 CHD 诊断的金标准，通过各项 3D-STI 参数对中度组及重度组患者进行 CHD 预测，并建立 OC 曲线，结果显示，中度组患者的 3D-Strain、GAS、GLS、GCS、GS 的曲线下面积(AUC)分别为 0 954、0 657、0890、0 938、0 940，重度组患者的 3D-Strain、GAS、GLS、GCS、GS 的 AUC 分别为 0 975、0 839、0 932、0 970、0 978;与中度组相比，重度组患者3D-Strain、GAS、GLS、GCS、GS 对应的 AUC 稍高。结论3D-STI 可作为 CHD 患者左心室冠状动脉狭窄的诊断方法，尤其对中重度狭窄患者具有极高的诊断价值，且具有重复性、无创、方便等优势，可为临床 CHD 患者的冠状动脉狭窄的诊断提供可靠依据。关键词心脏超声斑点成像技术;冠状动脉粥样硬化性心脏病;诊断;三维超声斑点追踪成像技术 中图分类号541 4;445 1 文献标识码A 收稿日期2022-07-26 基金项目山东省医药卫生科技发展计划项目(2019WS104)通信作者王燕，E-mail:ch_chq999163 comDiagnostic value of cardiac ultrasonic speckle imaging in coronary atherosclerotic heart diseaseCHEN Chun-qiang1，WANG Yan1，GUO Lei1，JIANG Kun2(1 Department of Cardiac Ultrasound，Liaocheng Second People sHospital/Liaocheng Second Hospital Affiliated to Shandong First Medical University，Liaocheng Shandong 252600，China;2 Department ofCardiology，Liaocheng Second People s Hospital/Liaocheng Second Hospital Affiliated to Shandong First Medical University，Liaocheng Shan-dong 252600，China)Abstract:ObjectiveTo investigate the diagnostic value of three-dimensional ultrasonic speckle tracking imaging technology(3D-STI)in coronary atherosclerotic heart disease(CHD)MethodsA total of 128 patients with suspected CHD in our hospital were selected andexamined by three-dimensional echocardiography to obtain the three-dimensional full-volume dynamic map of the heart，and analyzed by3D-STI According to the results of coronary angiography，the patients were divided into the normal group，mild group，moderate group andsevere group The age，gender，left atrial diameter(LAD)，left ventricular end-diastolic diameter(LVEDD)，interventricular septal thickness(IVST)，left ventricular mass(LVmass)，left ventricular ejection fraction(LVEF)and three dimensional LVEF(3D-LVEF)of patients ineach group were compared The global longitudinal strain(GLS)，global circumferential strain(GCS)，global area strain(GAS)，GAS rate，and 3D-Strain of left ventricle for patients in each group were measured，and the diagnostic value of each parameter of 3D-STI in CHD wereanalyzed esultsAmong 128 patients，27 patients had normal coronary artery(the normal group)，32 patients had mild coronary stenosis(the mild group)，37 patients had moderate coronary artery stenosis(the moderate group)，and 32 patients had severe coronary artery stenosis(the severe group)The LVEDD of the severe group was significantly larger than that of the other three groups(P 0 05)，the LVEF and3D-LVEF were significantly lower than those of the other three groups(P 0 05)，the LVmasswas significantly larger than that of the mildgroup and the normal group(P 0 05)There was no significant difference in the GAS rate among groups(P 0 05)The 3D-STI param-662局解手术学杂志J EG ANAT OPE SUG2023，32(3)http:/www jjssxzz cneters of the severe group were significantly lower than those of the other three groups(P 0 05)，the GS，GLS，GAS，GCS and 3D-Strain ofthe moderate group were lower than those of the normal group and the mild group(P 0 05)Taking the results of coronary angiography asthe gold standard for the diagnosis of CHD，CHD prediction was conducted for patients in the moderate group and the sever group by various3D-STI parameters，and the OC curve was established，which showed that the area under the curve(AUC)of 3D-Strain，GAS，GLS，GCS andGS in the moderate group were 0 954，0 657，0 890，0 938 and 0 940，respectively，and the AUC of 3D-Strain，GAS，GLS，GCS and GS inthe severe group were 0 975，0 839，0 932，0 970 and 0 978，respectively Compared with the moderate group，the AUC of 3D-Strain，GAS，GLS，GCS and GS in the severe group were slightly higher Conclusion3D-STI can be a diagnostic method for left ventricular coronaryartery stenosis in patients with CHD，especially it has extremely high diagnostic value for patients with moderate to severe coronary arterystenosis complicated with the advantages of repeatability，noninvasive and convenience，which can provide reliable clinical basis for thediagnosis of coronary artery stenosis in CHD patientsKeywords:cardiac ultrasonic speckle imaging;coronary atherosclerotic heart disease;diagnosis;three-dimensional ultrasonic speckletracking