CAJ | 학술논문

目的应用斑点追踪显像技术评价冠心病患者左室扭转和解旋运动的特征.方法 48例拟诊为冠心病,拟行冠状动脉造影、冠状动脉螺旋CT成像或心肌核素显像检查确诊,或行冠状动脉介入手术或冠状动脉搭桥手术治疗的患者.采集心尖左室长轴观、胸骨旁左室二尖瓣水平和心尖水平二维图像,应用二维应变分析软件分别获得左室二尖瓣水平和心尖水平短轴观整体的旋转角度一时间曲线,计算左室整体扭转角度峰值(Ptor)、扭转角度达峰时间(Tp-tor)、收缩末扭转角度(AVCtor)、等容舒张末扭转角度(MVOtor)和等容舒张解旋率(Untw-R).根据临床最终诊断结果,将所有研究对象分为三组:心肌梗死组19例,心肌缺血组19例,冠脉正常组10例.结果心肌缺血组基底段旋转角度峰值(Prot)和收缩末旋转角度(AVCrot)均明显小于心尖段,差异有统计学意义.心肌梗死组的Untw-R小于冠脉正常组,差异有统计学意义.Ptor与左心室舒张末期内径及射血分数之间存在直线相关关系.基底段的Prot与射血分数之间存在负的直线相关关系.Untw-R与射血分数和Ptor之间存在正的直线相关关系.结论心肌缺血患者左室心尖段旋转角度明显大于基底段,使心肌缺血患者左室整体表现为更为明显的逆时针扭转.心肌梗死组左室的舒张功能严重受损.Untw-R是反映心肌舒张功能的定量指标.
목적 응용반점추종현상기술평개관심병환자좌실뉴전화해선운동적특정.방법 48례의진위관심병,의행관상동맥조영、관상동맥라선CT성상혹심기핵소현상검사학진,혹행관상동맥개입수술혹관상동맥탑교수술치료적환자.채집심첨좌실장축관、흉골방좌실이첨판수평화심첨수평이유도상,응용이유응변분석연건분별획득좌실이첨판수평화심첨수평단축관정체적선전각도일시간곡선,계산좌실정체뉴전각도봉치(Ptor)、뉴전각도체봉시간(Tp-tor)、수축말뉴전각도(AVCtor)、등용서장말뉴전각도(MVOtor)화등용서장해선솔(Untw-R).근거림상최종진단결과,장소유연구대상분위삼조:심기경사조19례,심기결혈조19례,관맥정상조10례.결과 심기결혈조기저단선전각도봉치(Prot)화수축말선전각도(AVCrot)균명현소우심첨단,차이유통계학의의.심기경사조적Untw-R소우관맥정상조,차이유통계학의의.Ptor여좌심실서장말기내경급사혈분수지간존재직선상관관계.기저단적Prot여사혈분수지간존재부적직선상관관계.Untw-R여사혈분수화Ptor지간존재정적직선상관관계.결론 심기결혈환자좌실심첨단선전각도명현대우기저단,사심기결혈환자좌실정체표현위경위명현적역시침뉴전.심기경사조좌실적서장공능엄중수손.Untw-R시반영심기서장공능적정량지표.
Objective To evaluate left ventricular torsion and untwisting in patients with coronary artery disease by speckle tracking imaging. Methods Study population consisted of 48 patients, who were diagnosed coronary artery disease initially and received one of coronary arteriography, coronary artery spiral computerized tomography, radionuclide imaging, interventional therapy and bypass surgery. High frame rate (≥60 frame/s) two-dimensional dynamic images of the left ventricular apical long-axis views and parasternal short-axis views at basal and apical levels were recorded. Rotation was measured in the left ventricular short-axis views using 2D strain software. Left ventricular torsion was defined as relative rotation degree between the apical level and basal level. Patients were divided into three groups according to clinic final diagnosis [myocardial infarction ( MIN) group, n = 19; myocardial ischemia ( MIS) group, n =19; normal coronary artery (Contrast) group, n - 10]. Results In MIS group,peak rotation value and rotation value at aortic valve closure in basal level were smaller than those in apical level. Untwisting rate reduced in MIN group. There was linear correlation between left ventricular peak torsion and end-diastolic diameter. There was aslo linear correlation between left ventricular peak torsion and eject fraction. Left ventricular peak rotation at basal level was correlative to eject fraction. Left ventricular untwisting rate had linear correlation to eject fraction, and also had correlation to peak torsion. Conclusions In patients with myocardial ischemia, left ventricular rotation value at apical level is larger than that at basal level. Left ventricular diastolic function is injured severely in patients with myocardial infarction. Untwisting rate is a quantitative index to evaluate myocardial diastolic function.