CAJ | 학술논문

目的探讨应变延迟指数(SDI)评价无室壁运动异常的冠心病患者左心室同步性的临床价值.方法 135例冠心病呵疑的胸痛患者在冠状动脉造影前分别接受常规二维超声和斑点追踪显像检查.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),同时测量18个心肌节段纵向、径向及环向应变峰值与收缩末应变的差值之和作为纵向、径向及环向延迟指数(LSDI、RSDI及CSDI).结果根据冠状动脉造影结果将患者分为重度狭窄组、轻度狭窄组和对照组.冠脉重度狭窄组SDI、Tssl-SD、Tssl-Dif及Tssr-SD、Tssr-Dif较对照组显著增加(P＜0.001或P＜0.05)；重度狭窄组与轻度狭窄组间Tssl-SD、Tssl-Dif及LSDI、RSDI、CSDI差异有统计学意义(P＜0.05)；轻度狭窄组与对照组相比,除TssrSD外所有不同步参数差异均无统计学意义(P＞0.05).ROC曲线分析显示5种不同步指标检测重度冠脉狭窄的准确性依次为LSDI＞ RSDI＞ CSDI＞ Tssl-SD＞Tssl-Dif(曲线下面积分别为0.891、0.797、0.666、0.580、0.556).以LSDI≥-12.67％为截断值检测重度冠脉狭窄,具有最高的诊断价值(敏感性和特异性分别为80.6％和86.7％).结论 SDI能定量评价冠心病患者左室同步性,LSDI能更敏感地检测无明显节段性室壁运动异常的重度冠脉狭窄患者左室不同步.
목적 탐토응변연지지수(SDI)평개무실벽운동이상적관심병환자좌심실동보성적림상개치.방법 135례관심병가의적흉통환자재관상동맥조영전분별접수상규이유초성화반점추종현상검사.용이유응변연건분석심첨장축관、심첨량강관화사강관이급좌실단축관기저수평、유두기수평、심첨수평적도상,측량심전도QRS파기점지좌실재심첨장축관상적수축기종향응변체봉시간(Tssl)급흉골방단축관상적수축기경향화배향응변체봉시간(Tssr,Tssc).계산좌실각절단체봉시간표준차(Tssl-SD,Tssr-SD,Tssc-SD)급절단체봉시간최대차치(Tssl-Dif,Tssr-Dif,Tssc-Dif),동시측량18개심기절단종향、경향급배향응변봉치여수축말응변적차치지화작위종향、경향급배향연지지수(LSDI、RSDI급CSDI).결과 근거관상동맥조영결과장환자분위중도협착조、경도협착조화대조조.관맥중도협착조SDI、Tssl-SD、Tssl-Dif급Tssr-SD、Tssr-Dif교대조조현저증가(P＜0.001혹P＜0.05)；중도협착조여경도협착조간Tssl-SD、Tssl-Dif급LSDI、RSDI、CSDI차이유통계학의의(P＜0.05)；경도협착조여대조조상비,제TssrSD외소유불동보삼수차이균무통계학의의(P＞0.05).ROC곡선분석현시5충불동보지표검측중도관맥협착적준학성의차위LSDI＞ RSDI＞ CSDI＞ Tssl-SD＞Tssl-Dif(곡선하면적분별위0.891、0.797、0.666、0.580、0.556).이LSDI≥-12.67％위절단치검측중도관맥협착,구유최고적진단개치(민감성화특이성분별위80.6％화86.7％).결론 SDI능정량평개관심병환자좌실동보성,LSDI능경민감지검측무명현절단성실벽운동이상적중도관맥협착환자좌실불동보.
Objective To assess the left ventricular dyssynchrony in coronary artery disease(CAD) without visual segmental wall motion abnormalities using strain delay index (SDI).Methods A total of 135 patients under suspicion of CAD were recruited in this study.Two-dimensional cchocardiography was performed to collect dynamic images of left ventricular apical long axis views,tow-chamber views,four chamber views and parasternal short axis mitral views,papillary views and apical views.The time to minimal systolic longitudinal,radial,circumferential strain (Tssl,Tssr and Tssc) were measured from the start point of QRS wave in electrocardiogram.The left ventricular segmental standard deviation (Tssl-SD,Tssr-SD,Tssc-SD),maximal difference (Tssl-Dif,Tssr-Dif,Tssc-Dif) and longitudinal,radial,circumferential SDI (LSDI,RSDI,CSDI) of 18 left ventricular segments were calculated.Results According to coronary angiography results,patients were divided into three groups:severe stenosis group,mild stenosis group and control group.Compared with the other two groups,SDI and Tssl-SD,Tssl-Dif were decreased in severe stenosis group (P ＜0.001 or P ＜0.05).However,there were not significant differences between the mild stenosis group and the control group except Tssr-SD.The receiver operating characteristic (ROC) curves analysis demonstrated that LSDI had the highest accuracy and Tssl-SD had the lowest accuracy for detecting severe CAD (areas under the curve were 0.891,0.797,0.666,0.580 and 0.556 respectively).High sensitivity and specificity (80.6％ and 86.7％,respectively) were shown when using-12.67％ as a cutoff point of LSDI to diagnose severe CAD.Conclusions SDI can be helpful for assessing the left ventricular dyssynchrony in patients without visual segmental wall motion abnormalities,and LSDI is the most effective parameter to detecting severe CAD.