摘要
目的探讨三维斑点追踪成像(3D-STE)技术对静息状态下非心肌梗死冠状动脉多支重度狭窄的诊断价值。方法选择因胸痛、胸闷等症状疑诊冠心病入住我院并行冠状动脉造影的患者91例,根据造影结果将其分为3组:冠状动脉多支重度狭窄组(38例)、冠状动脉单支重度狭窄组(22例)和对照组(31例)。所有患者均接受二维及三维超声心动图检查,采用3D-STE技术自动测量左室整体纵向应变(3D GLS)、整体圆周应变(3D GCS)、整体面积应变(3D GAS)和整体径向应变(3D GRS)。ROC曲线分析其诊断冠状动脉多支重度狭窄的价值。结果与对照组相比,冠状动脉多支及单支重度狭窄组三维整体应变参数3D GLS、3D GCS、3D GAS和3D GRS均下降,差异有统计学意义(均P<0.05),其中多支重度狭窄组下降更显著,差异有统计学意义(均P<0.001);与单支重度狭窄组相比,多支重度狭窄组三维整体应变参数亦有下降,其中,仅3D GLS和3D GAS差异有统计学意义(均P<0.05)。ROC曲线分析显示,在四个三维整体应变参数中,当3D GLS截断值取-11%时,其预测冠状动脉多支重度狭窄敏感性较高,为84.2%;当3D GAS截断值取-20%时,其预测冠状动脉多支重度狭窄特异性较高为79.3%。联合诊断试验显示3D GLS与3D GCS、3D GAS和3D GRS任一指标并联使用时,其诊断冠脉多支重度狭窄的敏感性均较单一指标高。结论3D-STE对诊断冠状动脉多支重度狭窄有一定的临床价值,尤其3D GLS、3D GAS可作为诊断冠状动脉多支重度狭窄较为有效的参考指标。
Objective To evaluate the diagnosis value of three-dimensional speckle tracking echocardiography(3D-STE)in severe multi-vessel coronary stenosis at resting state.Methods Ninety-one patients with chest tightness,chest pain,other related clinical symptoms,and suspected coronary heart disease were enrolled and underwent coronary angiography(CAG),two and three-dimensional echocardiography(2D-STE,3D-STE).According to CAG results,the patients were divided into 3 groups:severe multi-vessel stenosis group(n=38),severe single-vessel stenosis group(n=22),and control group(n=31).All patients underwent two and three-dimensional echocardiography.3D-STE was applied to obtain left ventricular global longitudinal strain(3D GLS),global circumferential strain(3D GCS),global area strain(3D GAS)and global radial strain(3D GRS).Receiver operating curve analysis was conduct to evaluate the diagnosis value of 3D-STE in severe multi-vessel coronary stenosis at resting state.Results 3D GLS,3D GCS,3D GAS and 3D GRS were decreased in the severe multi-vessel group and single-vessel stenosis group compared to those in the control group(P<0.05);and greater decreases was observed in the severe multi-vessel stenosis group(P<0.001).Furthermore,3D GLS and 3D GAS in the severe multi-vessel stenosis group were lower than those in severe single-vessel stenosis group(P<0.05).ROC curve showed that the cutoff value for 3D GLS was≤-11% with a measurement sensitivity of 84.2% and cutoff value for 3D GAS was≤-20% with a measurement specificity of 79.3%.A joint diagnostic test showed that the sensitivity was increased when 3D GLS was combined with at least one other parameters.Conclusions 3D-STE shows a great diagnostic potential when applied to detect severe multi-vessel coronary stenosis.Moreover,GLS and GAS may act as more valuable indicators.
作者
李艳红
龚晓萍
穆玉明
吴治胜
Li Yanhong;Gong Xiaoping;Mu Yuming;Wu Zhisheng(Department of Echocardiography,the First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2018年第12期1020-1024,共5页
Chinese Journal of Ultrasonography
基金
新疆维吾尔自治区自然科学基金(面上项目)(2014211C054).
作者简介
通信作者:穆玉明,Email:mym1234@126.com
