三维应变显像舒张指数对冠心病患者左室舒张功能的临床研究

摘要

Objective To evaluate the left ventricular diastolic function in coronary heart disease (CHD) patients without regional wall motion abnormality by three dimensional SI-DI (Strain Imaging Diastolic Index) so as to investigate the effectiveness of application of three dimensional SI-DI in detecting CHD. Methods According to CAG (Coronary Angiography), 113 patients without regional wall motion abnormality were divided into three groups:None-CHD Group (n=35), Single-Branch Disease Group (n=37, single coronary stenosis≥50%), Multiple-Branch Disease Group (n=41, two or more than two coronary stenosis≥50%). Transthoracic acquisition of full-volume real-time three-dimensional images and conventional two-dimensional images were made to obtain two-dimensional and three-dimensional routine parameters, area, longitudinal, radial and circumferential end systolic strain and corresponding strain of 1/3 of pre-diastolic period. According to the formula calculation of area SI-DI (A-SI-DI), longitudinal SI-DI (L-SI-DI), radial SI-DI (R-SI-DI), circumferential SI-DI (C-SI-DI) was made. The effectiveness of each parameter in diagnosis of patients with coronary heart disease was analyzed. Results There were no signiifcant difference between the routine parameters of three groups (P>0.05). The longitudinal and area SI-DI in Single-Branch Disease Group were lower than these of None-CHD Group (P<0.05). The area, longitudinal, radial and circumferential SI-DI in Multiple-Branch Disease Group were lower than these of None-CHD Group (P<0.05);while, area, longitudinal and radial SI-DI in Multiple-Branch Disease Group were lower than these in Single-Branch Disease Group (P<0.05). The area, longitudinal, radial and circumferential SI-DI were signiifcantly correlated with Gensini score, r=(-0.689,-0.844,-0.510,-0.476) in None-CHD group, r=(-0.794,-0.768,-0.702,-0.589) in Single-Branch Disease Group, r=(0.806,-0.837,-0.714,-0.617) in Multiple-Branch Disease Group. Conclusion Three-dimensional SI-DI could quantitatively assess the left ventricular diastolic function and demonstrate its effectiveness in early detection and diagnosis of coronary heart disease.%目的：应用三维应变显像舒张指数（SI-DI）对无节段性室壁运动异常冠心病患者左室的舒张功能进行研究，探讨三维SI-DI诊断冠心病的价值。方法疑诊冠心病但无节段性室壁运动异常的患者113例，根据冠状动脉造影（CAG）结果分为3组：无冠心病组35例；单支病变（1支冠状动脉狭窄率≥50%）组37例；多支病变（2支或2支以上冠脉病变狭窄率≥50%）组41例。经胸采集实时三维全容积图像及常规二维图像，获得二维、三常规参数及面积、纵向、径向、圆周收缩末期应变及相应的舒张期前1/3点时的应变，根据公式计算面积SI-DI（A-SI-DI）、纵向SI-DI（L-SI-DI）、径向SI-DI（R-SI-DI）、圆周SI-DI（C-SI-DI），分析各参数对冠心病的诊断价值。结果二维及三维常规参数组间差异无统计学意义（P＞0.05），单支病变组A-SI-DI、L-SI-DI低于无冠心病组（P＜0.05）；多支病变组A-SI-DI、L-SI-DI、R-SI-DI、C-SI-DI低于无冠心病组（P＜0.05），A-SI-DI、L-SI-DI、R-SI-DI低于单支病变组（P＜0.05）。冠状动脉Gensini积分与A-SI-DI、L-SI-DI、R-SI-DI、C-SI-DI均有相关性（P＜0.05），分别为：无冠心病组（-0.689、-0.844、-0.510、-0.476），单支病变组（-0.794、-0.768、-0.702、-0.589），多支病变组（0.806、-0.837、-0.714、-0.617）。结论三维SI-DI可以定量评价冠心病患者左室舒张功能，对早期发现和诊断冠心病有重要意义。