二维应变超声评价心肌梗死患者节段性室壁运动减弱的临床研究

摘要

摘要:目的 评价二维应变超声诊断心肌梗死患者节段性室壁运动减弱的价值.方法 选择心肌梗死患者35例为心肌梗死组和健康体检者21例为对照组.采用超声心动图检查及超声二维斑点追踪技术,测定左心室各节段的峰值纵向应变(LS)、圆周应变(CS)和径向应变(RS),并按室壁运动评分将心肌梗死组患者左心室壁518个节段分为1分患者270个节段,2分患者116个节段,3分患者106个节段,≥4分患者26个节段；对照组为327个节段.对比各组LS、CS和RS的差异,并对各应变指标绘制ROC曲线.结果 与对照组比较,心肌梗死组的2分、3分和≥4分患者各节段LS、CS、RS明显降低(P＜0.01),1分患者节段LS和CS明显降低(P＜0.01),且1、2、3、≥4分患者左心室各节段随室壁运动评分的增加,LS、CS及RS明显降低(P＜0.01);ROC曲线诊断室壁运动减弱的敏感性分别为85.7％、76.5％、85.6％,特异性分别为74.5％、80.6％、64.3％.结论 二维应变超声中LS、CS和RS能准确评价心肌梗死患者节段性室壁运动减弱,其中LS、CS的诊断价值较高.%Objective To assess the value of two-dimensional strain echocardiography in evaluating segmental wall motion abnormality in patients with MI by two-dimensional speckle tracking imaging. Methods Thirty-five patients with MI and 21 healthy controls underwent routine echocardiography and two-dimensional speckle tracking imaging. Each segment of left ventricular wall was measured for the peak longitudinal strain(LS) ,peak circumferential strain(CS) and peak radial strain(RS). According to wall motion score(WMS) ,518 segments of the left ventricular wall in MI group were divided into four groups,WMS 1 was group 1 which had 270 segments, WMS 2 was group 2 which had 116 segments, WMS 3 was group 3 which had 106 segments, WMS≥4 was group 4 which had 26 segments. Healthy control group had 327 segments. LS,CS and RS were compared between the groups respectively,ROC curves were obtained for GLS,GCS and GRS respectively. Results LS,CS,RS were significantly lower in group 2, group 3 and group 4 than those in healthy control group, LS and CS in group 1 were significantly lower than those in healthy control group( P < 0. 01). With increase in WMS,LS,CS and RS desceased significantly (P< 0. 01). The sensitivity of LS,CS and RS for diagnosing wall motion abnormality were 85. 7%, 76. 5% and 85. 6% respectively,and the specificity were 74. 5% ,80. 6% and 64. 3% respectively. Conclusion Two-dimensional strain can accurately quantify segmental wall motion abnormality in MI patient. LS,CS have high diagnostic value in detecting early changes of myocardial dysfunction.