三维超声斑点追踪技术对冠状动脉多支重度狭窄的诊断价值

摘要

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 .%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-S T E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.