中华超声影像学杂志
中華超聲影像學雜誌
중화초성영상학잡지
CHINESE JOURNAL OF ULTRASONOGRAPHY
2013年
8期
654-658
,共5页
汪彩英%周青%张才智%陈金玲%胡波%宋宏宁%郭瑞强
汪綵英%週青%張纔智%陳金玲%鬍波%宋宏寧%郭瑞彊
왕채영%주청%장재지%진금령%호파%송굉저%곽서강
超声心动描记术%冠状动脉狭窄%心肌缺血%斑点追踪显像,三维
超聲心動描記術%冠狀動脈狹窄%心肌缺血%斑點追蹤顯像,三維
초성심동묘기술%관상동맥협착%심기결혈%반점추종현상,삼유
Echocardiography%Coronary stenosis%Myocardial ischemia%Speckle tracking imaging,three-dimensional
目的 应用三维斑点追踪技术(3D-STI)和二维斑点追踪技术(2D-STI)分析冠状动脉狭窄患者左心室局部和整体应变值,评价左心室收缩功能,比较两种技术检测冠状动脉狭窄的临床应用价值.方法 对照组32例,冠状动脉狭窄组39例(均经冠状动脉造影确诊),冠状动脉狭窄组心肌节段分为缺血节段和非缺血节段,经胸采集左室二维及全容积三维动态图像,进行脱机分析,3D-STI指标包括:三维长轴应变(3D-LS)、三维圆周应变(3D-CS)、三维径向应变(3D-RS)、三维面积应变(3D-AS)、三维整体长轴应变(3D-GLS)、三维整体圆周应变(3D-GCS)、三维整体径向应变(3D-GRS)、三维整体面积应变(3D-GAS)；2D-STI指标包括:二维长轴应变(2D-LS)、二维圆周应变(2D-CS)、二维径向应变(2D-RS)、二维整体长轴应变(2D-GLS)、二维整体圆周应变(2D-GCS)、二维整体径向应变(2D-GRS).比较二维和三维在冠状动脉狭窄组缺血节段和非缺血节段中的节段性应变均值及在对照组和冠状动脉狭窄组中的整体应变均值.并对2DSTI和3D-STI的整体应变值和左室射血分数(LVEF)进行相关性分析.结果 冠状动脉狭窄组缺血节段和非缺血节段的2D-LS、2D-CS、3D-LS、3D-CS、3D-AS差异有统计学意义(P＜0.05).其中缺血节段的2D-LS、3D-LS、3D-AS较非缺血节段明显减低(P＜0.001),ROC曲线表明2D-LS、3D-LS、3D-AS诊断冠状动脉狭窄患者心肌缺血的灵敏度分别为60.1％、64.2％、74.0％,特异度分别为60.0％、61.0％、63.1％.对照组和冠状动脉狭窄组的2D-GCS、2D-GRS差异无统计学意义(P＞0.05),而冠状动脉狭窄组的2D-GLS、3D-GLS、3D-GCS、3D-GRS、3D-GAS较对照组明显减低,差异有统计学意义(P＜0.05).ROC曲线表明2D-GLS、3D-GLS、3DGAS诊断冠状动脉狭窄的灵敏度分别为61.3％、73.3％、79.3％,特异度分别为65.4％、66.0％、70.8％.3D-GAS诊断冠状动脉狭窄的灵敏度和特异度最高.相关性分析显示2D-GLS、2D-GCS、2D-GRS与LVEF相关(r1=-0.668,P＜0.001；r2--0.551,P＜0.001；r3-0.310,P＜0.05),而3D-GLS、3D-GCS、3D-GRS、3D-GAS与LVEF亦相关(r1=-0.634,P1＜0.001；r2=-0.672,P2 ＜0.001；r3=0.698,P3 ＜0.001；r4=-0.707,P4 ＜0.001),其中3D-GAS与LVEF的相关性相对较高.结论 3D-STI较2D-STI能更准确评价冠状动脉狭窄患者早期左室局部及整体收缩功能的变化,而来源于3D-STI的面积应变检测冠状动脉狭窄的灵敏度和特异度更高些.
目的 應用三維斑點追蹤技術(3D-STI)和二維斑點追蹤技術(2D-STI)分析冠狀動脈狹窄患者左心室跼部和整體應變值,評價左心室收縮功能,比較兩種技術檢測冠狀動脈狹窄的臨床應用價值.方法 對照組32例,冠狀動脈狹窄組39例(均經冠狀動脈造影確診),冠狀動脈狹窄組心肌節段分為缺血節段和非缺血節段,經胸採集左室二維及全容積三維動態圖像,進行脫機分析,3D-STI指標包括:三維長軸應變(3D-LS)、三維圓週應變(3D-CS)、三維徑嚮應變(3D-RS)、三維麵積應變(3D-AS)、三維整體長軸應變(3D-GLS)、三維整體圓週應變(3D-GCS)、三維整體徑嚮應變(3D-GRS)、三維整體麵積應變(3D-GAS)；2D-STI指標包括:二維長軸應變(2D-LS)、二維圓週應變(2D-CS)、二維徑嚮應變(2D-RS)、二維整體長軸應變(2D-GLS)、二維整體圓週應變(2D-GCS)、二維整體徑嚮應變(2D-GRS).比較二維和三維在冠狀動脈狹窄組缺血節段和非缺血節段中的節段性應變均值及在對照組和冠狀動脈狹窄組中的整體應變均值.併對2DSTI和3D-STI的整體應變值和左室射血分數(LVEF)進行相關性分析.結果 冠狀動脈狹窄組缺血節段和非缺血節段的2D-LS、2D-CS、3D-LS、3D-CS、3D-AS差異有統計學意義(P＜0.05).其中缺血節段的2D-LS、3D-LS、3D-AS較非缺血節段明顯減低(P＜0.001),ROC麯線錶明2D-LS、3D-LS、3D-AS診斷冠狀動脈狹窄患者心肌缺血的靈敏度分彆為60.1％、64.2％、74.0％,特異度分彆為60.0％、61.0％、63.1％.對照組和冠狀動脈狹窄組的2D-GCS、2D-GRS差異無統計學意義(P＞0.05),而冠狀動脈狹窄組的2D-GLS、3D-GLS、3D-GCS、3D-GRS、3D-GAS較對照組明顯減低,差異有統計學意義(P＜0.05).ROC麯線錶明2D-GLS、3D-GLS、3DGAS診斷冠狀動脈狹窄的靈敏度分彆為61.3％、73.3％、79.3％,特異度分彆為65.4％、66.0％、70.8％.3D-GAS診斷冠狀動脈狹窄的靈敏度和特異度最高.相關性分析顯示2D-GLS、2D-GCS、2D-GRS與LVEF相關(r1=-0.668,P＜0.001；r2--0.551,P＜0.001；r3-0.310,P＜0.05),而3D-GLS、3D-GCS、3D-GRS、3D-GAS與LVEF亦相關(r1=-0.634,P1＜0.001；r2=-0.672,P2 ＜0.001；r3=0.698,P3 ＜0.001；r4=-0.707,P4 ＜0.001),其中3D-GAS與LVEF的相關性相對較高.結論 3D-STI較2D-STI能更準確評價冠狀動脈狹窄患者早期左室跼部及整體收縮功能的變化,而來源于3D-STI的麵積應變檢測冠狀動脈狹窄的靈敏度和特異度更高些.
목적 응용삼유반점추종기술(3D-STI)화이유반점추종기술(2D-STI)분석관상동맥협착환자좌심실국부화정체응변치,평개좌심실수축공능,비교량충기술검측관상동맥협착적림상응용개치.방법 대조조32례,관상동맥협착조39례(균경관상동맥조영학진),관상동맥협착조심기절단분위결혈절단화비결혈절단,경흉채집좌실이유급전용적삼유동태도상,진행탈궤분석,3D-STI지표포괄:삼유장축응변(3D-LS)、삼유원주응변(3D-CS)、삼유경향응변(3D-RS)、삼유면적응변(3D-AS)、삼유정체장축응변(3D-GLS)、삼유정체원주응변(3D-GCS)、삼유정체경향응변(3D-GRS)、삼유정체면적응변(3D-GAS)；2D-STI지표포괄:이유장축응변(2D-LS)、이유원주응변(2D-CS)、이유경향응변(2D-RS)、이유정체장축응변(2D-GLS)、이유정체원주응변(2D-GCS)、이유정체경향응변(2D-GRS).비교이유화삼유재관상동맥협착조결혈절단화비결혈절단중적절단성응변균치급재대조조화관상동맥협착조중적정체응변균치.병대2DSTI화3D-STI적정체응변치화좌실사혈분수(LVEF)진행상관성분석.결과 관상동맥협착조결혈절단화비결혈절단적2D-LS、2D-CS、3D-LS、3D-CS、3D-AS차이유통계학의의(P＜0.05).기중결혈절단적2D-LS、3D-LS、3D-AS교비결혈절단명현감저(P＜0.001),ROC곡선표명2D-LS、3D-LS、3D-AS진단관상동맥협착환자심기결혈적령민도분별위60.1％、64.2％、74.0％,특이도분별위60.0％、61.0％、63.1％.대조조화관상동맥협착조적2D-GCS、2D-GRS차이무통계학의의(P＞0.05),이관상동맥협착조적2D-GLS、3D-GLS、3D-GCS、3D-GRS、3D-GAS교대조조명현감저,차이유통계학의의(P＜0.05).ROC곡선표명2D-GLS、3D-GLS、3DGAS진단관상동맥협착적령민도분별위61.3％、73.3％、79.3％,특이도분별위65.4％、66.0％、70.8％.3D-GAS진단관상동맥협착적령민도화특이도최고.상관성분석현시2D-GLS、2D-GCS、2D-GRS여LVEF상관(r1=-0.668,P＜0.001；r2--0.551,P＜0.001；r3-0.310,P＜0.05),이3D-GLS、3D-GCS、3D-GRS、3D-GAS여LVEF역상관(r1=-0.634,P1＜0.001；r2=-0.672,P2 ＜0.001；r3=0.698,P3 ＜0.001；r4=-0.707,P4 ＜0.001),기중3D-GAS여LVEF적상관성상대교고.결론 3D-STI교2D-STI능경준학평개관상동맥협착환자조기좌실국부급정체수축공능적변화,이래원우3D-STI적면적응변검측관상동맥협착적령민도화특이도경고사.
Objective To analyzed the left ventricular (LV) regional and global strains in coronary artery stenosis by using three-dimensional speckle tracking imaging (3D-STI) and two-dimensional speckle tracking imaging (2D-STI) for the assessment of left ventricular systolic function,and to compare the clinical values between 3D-STI and 2D-STI in the detection of coronary stenosis.Methods 39 patients with coronary artery stenosis and 32 sex-age matched controls were enrolled in this study.Coronary artery stenosis group was divided into ischemic group and non-ischemic group.Real-time three dimensional full volume and two-dimensional dynamic image of the LV were obtained and then analyzed by off-line analysis software.The parameters of 3D-STI were three-dimensional longitudinal strain (3D-LS),circumferential strain (3D-CS),radial strain (3D-RS),area strain (3D-AS),global longitudinal strain (3D-GLS),global circumferential train (3D-GCS),global radial strain (3D-GRS) and global area strain (3D-GAS).The parameters of 2D-STI were two-dimensional longitudinal strain (2D-LS),circumferential strain (2D-CS),radial strain (2D-RS),global longitudinal strain (2D-GLS),global circumferential train (2D-GCS) and global radial strain (2D-GRS).The global/regional strains derived from 3D-STI and 2D-STI in patient group and controls were analyzed for comparing their efficacy in detecting coronary artery stenosis.Results Compared with non-ischemic group,2D-LS,2D-CS,3D-LS,3D-CS and 3D-AS were lower in ischemic group (P ＜0.05).ROC curves showed the sensitivity of 2D-LS,3D-LS and 3D-AS for the diagnosis of myocardial ischemia was 60.1％,64.2 ％ and 74.0 ％,while the specificity of them was 60.0％,61.0％ and 63.1％,respectively.There was no significant difference in 2D-GCS and 2D-GRS between coronary artery stenosis group and control group (P ＞ 0.05).Compared with control group,2D-GLS,3D-GLS,3D-GCS,3D-GRS and 3D-GAS were significantly lower in coronary artery stenosis group (P ＜0.05).ROC curves showed the sensitivity of 2D-GLS,3D-GLS and 3D-GAS in the diagnosis of coronary artery stenosis was 61.3％,73.3％ and 79.3 ％,while the specificity was 65.4％,66.0 ％ and 70.8 ％,respectively.The sensitivity and specificity of 3D-GAS were the highest in these parameters.It is revealed that 2D-GLS,2D-GCS and 2D-GRS were correlated with LVEF (r1 =-0.668,P1 ＜0.001 ;r2 =-0.551,P2 ＜0.001 ;r3 =0.310,P3 ＜0.05),and 3D-GLS,3D-GCS,3D-GRS,3D-GAS were correlated with LVEF (r1 =-0.634,P1 ＜0.001 ;r2 =-0.672,P2＜0.001 ;r3 =0.698,P3＜0.001 ;r4 =-0.707,P4＜0.001).The correlate of 3D-GAS and LVEF was higher than other parameters.Conclusions 3D-STI is superior to 2D-STI in assessing regional and global left ventricular systolic function in patients with coronary artery stenosis,and 3D-GAS derived from 3D-STI is a ideal parameter of detecting significant coronary artery stenosis based on its highest sensitivity and specificity.
