CAJ | 학술논문

目的应用三维斑点追踪技术获取左前降支(LAD)供血心肌节段的舒张期面积应变指数(ASI-DI),探讨其在判断LAD重度狭窄以及定位狭窄部位方面的价值.方法自2012年7月至2014年4月,入选在武汉大学人民医院拟诊冠心病的住院患者92例进行回顾性分析.冠状动脉造影前检查超声心动图,研究对象的左心室射血分数≥50％,且无节段性室壁运异常.根据LAD狭窄程度,将患者分为3组:重度狭窄组(狭窄程度≥75％),共36例;轻中度狭窄组(狭窄程度1％～74％),共22例;对照组(冠状动脉无狭窄),共34例.应用三维斑点追踪技术获取整体收缩期峰值面积应变(GPSAS)、整体舒张期面积应变指数(GASI-DI)以及节段心肌的ASI-DI等超声心动图参数.绘制节段心肌ASI-DI判断LAD重度狭窄的受试者工作特征(ROC)曲线,获取最优节段和截断值.结果重度狭窄组、轻中度狭窄组和对照组之间的GPSAS差异无统计学意义[分别为(-25.2±6.2)％、(-20.3±6.6)％和(-21.3±8.6)％,P=0.159].重度狭窄组的GASI-DI值均小于轻中度狭窄组和对照组[分别为(-34.3±14.7)％、(-48.1±13.3)％和(-59.4±12.2)％,P均＜0.01],轻中度狭窄组的GASI-DI值与对照组比较差异无统计学意义(P=0.217).前壁基底段ASI-DI判断LAD近段重度狭窄的ROC曲线下面积为0.829,截断值为40.3％,敏感度和特异度分别为0.96和0.63;前间壁中间段ASI-DI判断LAD中远段重度狭窄的ROC曲线下面积为0.843,截断值为38.8％,敏感度和特异度分别为0.967和0.651.结论 ASI-DI可以筛选出左心室射血分数≥50％且无节段性室壁运异常的LAD重度狭窄患者.前壁基底段和前间壁中间段ASI-DI能够较好地分别定位LAD近段和中远段重度狭窄.
목적 응용삼유반점추종기술획취좌전강지(LAD)공혈심기절단적서장기면적응변지수(ASI-DI),탐토기재판단LAD중도협착이급정위협착부위방면적개치.방법 자2012년7월지2014년4월,입선재무한대학인민의원의진관심병적주원환자92례진행회고성분석.관상동맥조영전검사초성심동도,연구대상적좌심실사혈분수≥50％,차무절단성실벽운이상.근거LAD협착정도,장환자분위3조:중도협착조(협착정도≥75％),공36례;경중도협착조(협착정도1％～74％),공22례;대조조(관상동맥무협착),공34례.응용삼유반점추종기술획취정체수축기봉치면적응변(GPSAS)、정체서장기면적응변지수(GASI-DI)이급절단심기적ASI-DI등초성심동도삼수.회제절단심기ASI-DI판단LAD중도협착적수시자공작특정(ROC)곡선,획취최우절단화절단치.결과 중도협착조、경중도협착조화대조조지간적GPSAS차이무통계학의의[분별위(-25.2±6.2)％、(-20.3±6.6)％화(-21.3±8.6)％,P=0.159].중도협착조적GASI-DI치균소우경중도협착조화대조조[분별위(-34.3±14.7)％、(-48.1±13.3)％화(-59.4±12.2)％,P균＜0.01],경중도협착조적GASI-DI치여대조조비교차이무통계학의의(P=0.217).전벽기저단ASI-DI판단LAD근단중도협착적ROC곡선하면적위0.829,절단치위40.3％,민감도화특이도분별위0.96화0.63;전간벽중간단ASI-DI판단LAD중원단중도협착적ROC곡선하면적위0.843,절단치위38.8％,민감도화특이도분별위0.967화0.651.결론 ASI-DI가이사선출좌심실사혈분수≥50％차무절단성실벽운이상적LAD중도협착환자.전벽기저단화전간벽중간단ASI-DI능구교호지분별정위LAD근단화중원단중도협착.
Objective To evaluate the value of locating and defining severe stenosis of left anterior descending (LAD) with area strain imaging diastolic indexes (ASI-DI) derived from three dimensional speckle tracking imaging (3D-STI).Methods A total of 92 suspected coronary heart disease patients with left ventricular ejection fraction (LVEF) ≥ 50％ and without regional wall motion abnormality,who underwent echocardiography before coronary angiography in our department from July 2012 to April 2014,were included in this retrospective study.Patients were divided into three groups by the level of LAD stenosis:severe stenosis group (≥75％,n =36),mild to moderate stenosis group (1％-74％,n =22) and control group (without coronary artery stenosis,n =34).Global peak systolic area strain (GPSAS),global ASI-DI (GASI-DI),and ASI-DI of the regional myocardial segments with blood supplied by LAD were measured.Receiver operating curves (ROC) were obtained between ASI-DI and stenosis level of LAD to locate and to find out the optimal segment and cutoff values.Results There was no significant difference of GPSAS among serious stenosis group,mild and moderate stenosis group and control group ((-25.2 ± 6.2)％ vs.(-20.3 ±6.6)％ vs.(-21.3 ±8.6)％,P =0.159).GASI-DI was significantly lower in severe stenosis group than in mild to moderate stenosis group and control group ((-34.3 ± 14.7) vs.(-48.1±13.3)％ vs.(-59.4 ± 12.2)％,both P＜0.01).GASI-DI was similar between mild to moderate stenosis group and control group (P =0.217).The optimal cutoff values of ASI-DI were 40.3％ and area under the curve (AUC) were 0.829 in the base anterior segment for detecting proximal severe stenosis of LAD (sensitivity 0.967,specificity 0.651),38.3％ and 0.843 in the middle anteroseptum for detecting mid-distal sever stenosis of LAD (sensitivity 0.967,specificity 0.651).Conclusions Patients with severe LAD stenosis can be screened by ASI-DI among patients with LVEF≥50％ and without regional wall motion abnormality.The ASI-DI of base anterior segment and middle anteroseptum can be used to locate the proximal and mid-distal sever stenosis of LAD.