Objective To investigate the feasibility of the three-dimensional speckle tracking imaging (3D-STI) technology in the assessment of left ventricular regional function of patients with varying degrees of coronary artery stenosis and its diagnostic value for coronary heart disease.Methods A total of 108 patients suspected of coronary heart disease were selected.We preformed three-dimensional (3D) echocardiography in the selected patients,and collected and stored the 3D volume dynamic images of the heart which were analyzed with 3D-STI technology offiine.The corresponding global long axis systolic peak strain (GLS),global radial axis systolic peak strain (GRS),global circumferential axis systolic peak strain (GCS),global area axis systolic peak strain (GAS),global area axis systolic peak strain rate (GAS rate) and 3D-Strain were measured.According to the coronary angiography results,all patients were divided into 4 groups,including normal coronary artery,mild coronary stenosis,moderate coronary stenosis and severe coronary stenosis.The sensitivity and specificity of 3D-STI parameters in the diagnosis of coronary heart disease were analyzed.Results Based on the coronary angiography examination,normal coronary artery was confirmed in 23 cases,mild coronary stenosis in 27 cases,moderate coronary stenosis in 31 cases and severe coronary stenosis in 27 cases.Compared with the other three groups,severe coronary stenosis group showed significantly higher left ventricular end-diastolic diameter [(52.3±6.2) ram],and obviously lower left ventricular ejection fraction and left ventricular ejection fraction measured by 3D echocardiography [(54.6±8.8)％ and (43.8±8.6)％,respectively;P＜0.05].And the left ventricular mass of severe coronary stenosis group was (183.7±15.2) g,significantly higher than that in normal coronary artery group and mild coronary stenosis group.The 3D-STI parameters in severe coronary stenosis group were significantly lower than those in the other three groups (P＜0.05).GLS,GRS,GCS,GAS and 3D-Strain in moderate coronary stenosis group were lower than those in normal coronary artery group and mild coronary stenosis group (P＜0.05).The area under the curve (AUC) of parameters to diagnose the moderate and severe coronary stenosis was 0.698-0.972,and the AUC values of GAS and GLS were the largest,with a higher sensitivity and specificity than other parameters.Conclusion 3D-STI technology provides an accurate,convenient and non-invasive method for the diagnosis of the moderate-severe coronary artery stenosis and the evaluation of left ventricular regional function of patients with coronary artery stenosis.%目的:探讨三维斑点追踪成像(3D-STI)对不同程度冠状动脉狭窄患者左心室局部功能评价及冠心病的诊断价值.方法:选取冠心病疑似患者108例作为研究对象.所有患者均行三维超声心动图检查,采集并存储心脏三维全容积动态图.脱机后利用3D-STI分析心脏三维全容积动态图,并测量患者左室整体长轴收缩期峰值应变(GLS)、左室整体径向收缩期峰值应变(GRS)、左室整体圆周收缩期峰值应变(GCS)、左室整体面积收缩期峰值应变(GAS)、左室整体面积收缩期峰值应变变化率和三维左室整体应变(3D-Strain).根据冠脉造影(CAG)结果将所有患者分为冠脉正常、冠脉轻度狭窄、冠脉中度狭窄和冠脉重度狭窄4组.分析各3D-STI参数在冠心病诊断中的敏感性和特异性.结果:CAG检查确认,冠脉正常23例、冠脉轻度狭窄27例、冠脉中度狭窄31例、冠脉重度狭窄27例.冠脉重度狭窄组左室舒张末期内径为(52.3±6.2) mm,显著高于其他3组,左室质量为(183.7±15.2)g,显著高于冠脉正常和冠脉轻度狭窄组,左室射血分数和三维超声测量的左室射血分数分别为(54.6±8.8)％和(43.8±8.6)％,均显著低于其他3组(P＜0.05).冠脉重度狭窄组各项3D-STI参数均显著低于其余3组(P＜0.05);冠脉中度狭窄组患者GLS、GRS、GCS、GAS和3D-Strain均低于冠脉轻度狭窄组和冠脉正常组患者(P＜0.05).各参数对冠脉中-重度狭窄诊断的曲线下面积(AUC)为0.698～0.972,其中GAS和GLS的AUC值最大,敏感度和特异度均高于其他参数.结论:3D-STI为冠状动脉狭窄患者左心室局部功能和冠脉中-重度狭窄患者评价和诊断提供了一种准确、方便、无创的方法,具有较好的临床应用价值.
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