斑点追踪成像技术评价冠状动脉不同狭窄程度患者的左室扭转运动

摘要

Objective To assess the value and characteristics of left ventricular (LV) twist in patients with different degree of coronary artery stenosis by speckle tracking imaging ( STI). Methods One hundred and seventeen patients with coronary heart disease were divided into myocardial infarction group(60 cases) ,myocardial ischemia group(31 cases) and control group(26 cases) according to the results of coronary artery angiography or computed tomography. The left ventricular end of diastole diameter( LVDd) , left ventricular end-systolic diameter( LVDs) , left ventricular end-diastolic volume( LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), peak systolic velocity of lateral mitral valve annular (S') and Tei index were all measured by routine echocardiography. Rotation and rotation rate of mitral valve level and apical level, torsion and torsion rate, which were the parameters of twist were analyzed by STI. Results Compared with myocardial ischemia group and control group, the LVDd, LVDs, LVEDV, LVESV and Tei index were increased, while LVEF and S' were decreased, there was signicant difference (P<0.05). Compared with control group, the rotation and rotation rate of apical level, rotation rate of mitral valve level and torsion and torsion rate were decreased, there was significant difference (P< 0.05), especially in myocardial infarction group ( P<0.01). There was good positive correlation between torsion and LVEF ( r= 0.618, P<0.001). Conclusion The more severity of coronary artery stenosis in patients with coronary heart disease, the more reduction in LV twist, especially in patients with myocardial infarction. LV twist derived by STI is more sensitive to evaluate LV dysfunction in systole in patients with myocardial ischemia than routine parameters of echocardiography.%目的 应用斑点追踪成像(STI)技术评价冠状动脉不同狭窄程度患者左室扭转运动的特点及规律性.方法 临床拟诊为冠心病患者117例,根据冠状动脉造影或冠状动脉CT结果分成心肌梗死组(60例)、心肌缺血组(31例)及对照组(26例),常规超声测量左室收缩及舒张末期内径(LVDs,LVDd)、容积(LVVESV,LVEDV)及射血分数(LVEF),组织多普勒测量二尖瓣后瓣环收缩期峰值运动速度(S')及Tei指数,运用STI技术分析左室二尖瓣水平与心尖水平旋转运动、整体扭转运动,测定旋转角度/率、扭转角度/率.结果 与心肌缺血组及对照组比较,心肌梗死组LVDd、LVDs、LVEDV、LVESV及Tei指数均增大,LVEF及S'减低,差异均有统计学意义(P<0.05).与对照组比较,心肌梗死组及心肌缺血组左室心尖水平旋转角度/率、二尖瓣水平旋转率、扭转角度/率均减低,差异均有统计学意义(P<0.05),以心肌梗死组减低更为显著(P<0.01).左室整体的扭转角度与LVEF呈较强的正相关(r=0.618,P<0.001).结论 冠心病患者的冠状动脉狭窄程度越严重,左室整体的扭转运动受损越明显,以心肌梗死组减低更为显著.应用STI评价左室的扭转运动与常规超声参数相比较,能更好地反映心肌缺血患者的左心室收缩运动.