CAJ | 학술논문

目的：应用超声三维斑点追踪成像（3D-STI）技术获取冠心病患者左心室整体应变参数，评价冠心病患者左心室整体收缩功能及其临床应用价值。方法冠心病患者30例，对照组20例。经胸采集心尖全容积三维图像，应用三维斑点追踪分析软件测量两组病例左室整体长轴应变值（GLS）、整体圆周应变值（GCS）、整体径向应变值（GRS）及整体面积应变值（GAS）。分析两组间各参数的差异并对各参数与左室射血分数（LVEF）之间的相关性进行分析。结果与对照组比较，冠心病组GRS、GCS、GLS、GAS较对照组明显减低，差异有统计学意义（t=2.79，P＜0.01；t=2.73，P＜0.01；t=3.70，P＜0.001；t=3.40，P＜0.001）。ROC曲线分析GRS、GCS、GLS、GAS诊断冠心病的敏感性分别为65.7%、63.2%、75.6%、83.9%，特异性分别为62.3%、64.2%、69.1%、75.8%，GAS诊断冠心病心肌缺血的敏感性和特异性最高。GLS、GCS、GAS与LVEF之间呈负相关。r分别为-0.632、-0.671、-0.656，均为P＜0.001；GRS与LVEF之间呈正相关，r为0.629，P＜0.001。结论3D-STI技术测量的面积应变等参数能较敏感地评价冠心病患者早期左室整体收缩功能的变化。
목적：응용초성삼유반점추종성상（3D-STI）기술획취관심병환자좌심실정체응변삼수，평개관심병환자좌심실정체수축공능급기림상응용개치。방법관심병환자30례，대조조20례。경흉채집심첨전용적삼유도상，응용삼유반점추종분석연건측량량조병례좌실정체장축응변치（GLS）、정체원주응변치（GCS）、정체경향응변치（GRS）급정체면적응변치（GAS）。분석량조간각삼수적차이병대각삼수여좌실사혈분수（LVEF）지간적상관성진행분석。결과여대조조비교，관심병조GRS、GCS、GLS、GAS교대조조명현감저，차이유통계학의의（t=2.79，P＜0.01；t=2.73，P＜0.01；t=3.70，P＜0.001；t=3.40，P＜0.001）。ROC곡선분석GRS、GCS、GLS、GAS진단관심병적민감성분별위65.7%、63.2%、75.6%、83.9%，특이성분별위62.3%、64.2%、69.1%、75.8%，GAS진단관심병심기결혈적민감성화특이성최고。GLS、GCS、GAS여LVEF지간정부상관。r분별위-0.632、-0.671、-0.656，균위P＜0.001；GRS여LVEF지간정정상관，r위0.629，P＜0.001。결론3D-STI기술측량적면적응변등삼수능교민감지평개관심병환자조기좌실정체수축공능적변화。
Objective To explore the clinical value of three-dimensional speckle tracking imaging (3D-STI) in the assessment of global left ventricular (LV) systolic function in patients with coronary heart disease (CHD) by measuring left ventricular global strains.Methods30 patients with coronary artery stenosis and 20 matched normal controls were enrolled in this study. Full volumetric real-time three dimensional data of the left ventricle was collected from all subjects. The parameters of longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), radial peak systolic strain (GRS) and area peak systolic strain (GAS) were obtained using the 3DT analysis software. The differences between any two sets of the parameters were analyzed and the correlations between LVEF and each global parameter were also investigated.Results There were significant differences in all global strain parameters between control group and CHD group (t=2.79,P<0.01,t=2.73,P<0.01,t=3.70,P<0.001 andt=3.40,P<0.001) for GRS, GCS, GRS and GAS, respectively). ROC curves showed that the sensitivities of GRS,GCS,GLS and GAS in the diagnosis of coronary heart disease were 65.7%, 63.2%, 75.6% and 83.9%, respectively. While the specificities for GRS, GCS, GRS and GAS were 62.3%, 64.2%, 69.1% and 75.8%. GAS had the highest sensitivity and specificity among all parameters. In addition, Negative correlations were observed between 3D-STI measurements and LVEF (GLS:r=-0.632, GCS:r=-0.671, GAS:r=-0.656,P<0,001 for all). However, GRS was correlated with LVEF positively (r=0.629,P<0.001).ConclusionThree-dimensional speckle tracking can be used to evaluate the myocardial systolic function changes at early stage for patients with coronary heart disease.