摘要
目的应用颈动脉超声和三维斑点追踪技术(3D-STE)分别评估老年冠心病(CHD)合并高血压(EH)患者颈动脉狭窄及左心功能情况,探讨其临床应用价值。方法选取我院收治的老年CHD合并EH患者(合并组)和同期单纯CHD患者(CHD组),每组各60例;应用颈动脉超声获取颈总动脉内-中膜厚度(IMT)、狭窄程度和颈动脉斑块(Crouse)积分,3D-STE获取左房最小和最大容积(LAVmin、LAVmax)、左房收缩前容积指数(LAVIp)、左房最小和最大容积指数(LAVImin、LAVImax)、左房主动射血分数(LAAEF)、左房整体射血分数(LATEF)、左室射血分数(LVEF)、左室收缩期整体面积应变(GAS)、整体圆周应变(GCS)、整体径向应变(GRS)、整体纵向应变(GLS)、整体左房峰值纵向应变(PALS)、整体左房收缩峰值应变(PACS),比较两组上述参数的差异。分析颈动脉超声参数与3D-STE参数的相关性。采用多因素Logistic回归分析筛选预测老年CHD合并EH患者颈动脉狭窄及左心功能改变的独立影响因素。结果合并组与CHD组颈总动脉IMT、狭窄程度、Crouse积分比较差异均有统计学意义(均P<0.001)。合并组LAVmin、LAVmax、LAVIp、LAVImin、LAVImax和LAAEF均高于CHD组,LATEF、LVEF、GAS、GCS、GRS、GLS、PALS、PACS均低于CHD组,差异均有统计学意义(均P<0.001)。相关性分析显示,IMT、狭窄程度、Crouse积分与LAVmin、LAVmax、LAVIp、LAVImin、LAVImax、LAAEF、LATEF、LVEF均呈正相关(均P<0.05),与GAS、GCS、GRS、GLS、PALS、PACS均呈负相关(均P<0.05)。多因素Logistic回归分析结果显示,颈总动脉IMT、狭窄程度、Crouse积分均为预测老年CHD合并EH患者颈动脉狭窄的独立影响因素(均P<0.05),LAAEF、GAS、PALS、PACS均为预测其左心功能改变的独立影响因素(均P<0.05)。结论颈动脉超声和3D-STE可较好地评估老年CHD合并EH患者颈动脉狭窄和左心功能情况,具有一定的临床价值。
Objective To evaluate the carotid stenosis and left heart function in elderly patients with coronary heart disease(CHD)combined with hypertension(EH)by carotid ultrasound and three-dimensional speckle tracking echocardiography(3D-STE),and to explore their clinical application value.Methods A total of 60 elderly patients with CHD combined with EH and 60 patients with single CHD in our hospital were enrolled as combination group and CHD group,respectively.The intimamedia thickness(IMT)of common carotid artery,stenosis degree and carotid plaques(Crouse)score were obtained by carotid ultrasound.The left atrial minimal and maximal volume(LAVmin,LAVmax),left atrial pre-systolic volume index(LAVIp),left atrial minimal and maximal volume index(LAVImin,LAVImax),left atrial active ejection fraction(LAAEF),left atrial total ejection fraction(LATEF),left ventricular ejection fraction(LVEF),global area strain(GAS),global circumferential strain(GCS),global radial strain(GRS),global longitudinal strain(GLS),left atrial peak atrial longitudinal strain(PALS)and left atrial peak atrial contraction strain(PACS)were obtained by 3D-STE,the differences of the above parameters between the two groups were compared.The correlation between carotid ultrasound parameters and 3D-STE parameters was analyzed.The independent influencing factors for predicting carotid stenosis and left ventricular function changes in elderly patients with CHD combined with EH were screened by multivariate Logistic regression analysis.Results There were significant differences in IMT of common carotid artery,stenosis degree and Crouse score between combination group and CHD group(all P<0.001).LAVmin,LAVmax,LAVIp,LAVImin,LAVImax and LAAEF in combination group were higher than those in CHD group,while LATEF,LVEF,GAS,GCS,GRS,GLS,PALS and PACS were lower than those in CHD group(all P<0.001).Correlation analysis showed that IMT of common carotid artery,stenosis degree and Crouse score were positively correlated with LAVmin,LAVmax,LAVIp,LAVImin,LAVImax,LAAEF,LATEF and LVEF(all P<0.05),while negatively correlated with GAS,GCS,GRS,GLS,PALS and PACS(all P<0.05).Multivariate Logistic regression analysis showed that IMT of common carotid artery,stenosis degree,Crouse score were independent influencing factors for predicting carotid stenosis in elderly patients with CHD combined with EH(all P<0.05),and LAAEF,GAS,PALS,PACS were independent influencing factors for predicting left heart function changes(all P<0.05).Conclusion Carotid ultrasound and 3D-STE can evaluate carotid stenosis and left heart function changes in elderly patients with CHD and EH,which has a certain clinical value.
作者
李昕
邓懋恩
杨银广
LI Xin;DENG Maoen;YANG Yinguang(Department of Ultrasound,Songshan Lake Central Hospital,Guangdong 523320,China)
出处
《临床超声医学杂志》
CSCD
2024年第12期1042-1046,共5页
Journal of Clinical Ultrasound in Medicine
关键词
超声心动描记术
三维
超声检查
颈动脉
冠心病
高血压
颈动脉狭窄
左心功能
Echocardiography,three-dimensional
Ultrasonography,carotid
Coronary heart disease
Hypertension
Carotid stenosis
Left heart function
作者简介
通讯作者:杨银广,Email:ttaaff995@yeah.net。
