CAJ | 학술논문

目的探讨二维斑点追踪应变成像技术评价冠心病患者左室同步性的临床价值.方法 42例急性心肌梗死患者、39例冠心病心肌缺血患者和32例对照者接受二维超声检查,用二维应变软件分析心尖长轴观、心尖两腔观和四腔观以及左室短轴观基底水平、乳头肌水平、心尖水平的图像,测量自心电图QRS波起点至左室在心尖长轴观上的收缩期纵向应变达峰时间(Tssl)及胸骨旁短轴观上的收缩期径向和环向应变达峰时间( Tssr,Tssc).计算左室各节段达峰时间标准差(Tssl-SD,Tssr-SD,Tssc-SD)及节段达峰时间最大差值(Tssl-Dif,Tssr-Dif,Tssc-Dif),以左室短轴观乳头肌水平前室间隔和后壁的径向应变的达峰时间之差(TAS-POST)≥130 ms作为左室收缩不同步标准,同时测量18个心肌节段纵向应变峰值与收缩末应变的差值之和作为纵向应变延迟指数(LSDI),LSDI≥25％作为左室不同步标准.结果急性心肌梗死组同步性参数较对照组增加(P ＜0.001或P＜0.05)；心肌缺血组同步性参数较对照组增高(P＜0.05); LSDI与TAS-POST呈正向线性相关(r=0.676,P＜0.05)；急性心肌梗死组中,LSDI检测左室不同步敏感性高于TAs-POST(P＜0.05).结论二维斑点追踪应变成像技术能准确评价左室不同步性,LSDI与TAS-POST可定量评价冠心病患者左室不同步性.
목적 탐토이유반점추종응변성상기술평개관심병환자좌실동보성적림상개치.방법 42례급성심기경사환자、39례관심병심기결혈환자화32례대조자접수이유초성검사,용이유응변연건분석심첨장축관、심첨량강관화사강관이급좌실단축관기저수평、유두기수평、심첨수평적도상,측량자심전도QRS파기점지좌실재심첨장축관상적수축기종향응변체봉시간(Tssl)급흉골방단축관상적수축기경향화배향응변체봉시간( Tssr,Tssc).계산좌실각절단체봉시간표준차(Tssl-SD,Tssr-SD,Tssc-SD)급절단체봉시간최대차치(Tssl-Dif,Tssr-Dif,Tssc-Dif),이좌실단축관유두기수평전실간격화후벽적경향응변적체봉시간지차(TAS-POST)≥130 ms작위좌실수축불동보표준,동시측량18개심기절단종향응변봉치여수축말응변적차치지화작위종향응변연지지수(LSDI),LSDI≥25％작위좌실불동보표준.결과 급성심기경사조동보성삼수교대조조증가(P ＜0.001혹P＜0.05)；심기결혈조동보성삼수교대조조증고(P＜0.05); LSDI여TAS-POST정정향선성상관(r=0.676,P＜0.05)；급성심기경사조중,LSDI검측좌실불동보민감성고우TAs-POST(P＜0.05).결론 이유반점추종응변성상기술능준학평개좌실불동보성,LSDI여TAS-POST가정량평개관심병환자좌실불동보성.
Objective To assess the clinical values of the longitudinal strain delay index(LSDI) and the delay of time in peak anterospetal wall to posterior wall strain(TAS-POST),which are analyzed by speckle tracking imaging,was discussed in the article.Methods The study included 39 patients with acute myocardial infarction,37 patients with coronary heart disease but not acute myocardial infarction which was confirmed by selective coronary angiography and 30 age-gender-related volunteers.Two-dimensional echocardiography was performed to collect dynamic images of left ventricular apical long axis view,two-chamber view,four-chamber view and parasternal short axis mitral view,papillary view and apical view.The time to minimal systolic longitudinal,radial,circumferential strain (Tssl,Tssr and Tssc) were measured from the start point of QRS wave of electrocardiogram.The left ventricular segmental standard deviation (Tssl-SD,Tssr-SD,Tssc-SD) and maximal difference (Tssl-Dif,Tssr-Dif,Tssc-Dif) were calculated.The left ventricular dyssynchrony was defined as TAS-POST≥130 ms and LSDI≥25％.Results The dyssynchrony parameters in the acute myocardial infarction group were significantly increased compared to the control group ( P ＜0.001 or P ＜0.05 ).The parameters in the myocardial ischemia group were also higher than those in the control group ( P ＜0.05).Linear regression showed that LSDI was positive correlated with TAS-POST( r =0.676,P ＜0.05).In acute myocardial infarction group,LSDI was more sensitive in the detection of left ventricular dyssynchrony than TAS-POST ( P ＜ 0.05 ).Conclusions Left ventricular dyssynchrony can be evaluate accurately by speckle tracking imaging.LSDI and TAS-POST are quantitative parameters for the evaluation of left ventricular dyssynchrony in coronary heart disease.