目的:应用二维斑点追踪技术(2DSTI)评价不同程度冠脉狭窄患者左室收缩功能以及收缩同步性。方法109例拟诊冠心病患者接受常规二维超声和斑点追踪检查。根据造影结果分为对照组和冠心病组,同时根据Gensini积分将冠心病组分为3个亚组,轻度组(<25分),中度病变组(25~50分),重度病变组(>50分)。对所采集的高频帧二维图像脱机应用CMQ软件分析,测量左室整体纵向( GLS)及圆周峰值应变( GCS),同时测量心电图QRS波起点至左室长轴上的收缩期纵向应变达峰时间( Tssl)及短轴观的收缩期圆周应变达峰时间( Tssc)。计算左室16节段纵向、圆周达峰时间标准差( Tssl-SD、Tssc-SD)以及纵向、圆周达峰时间最大差值(Tssl-Diff、Tssc-Diff),以时间标准差和最大差值作为不同步性指标。结果①与对照组比较,冠心病各组年龄、收缩压、舒张压、体重指数( BMI )、心率、二尖瓣舒张早期血流速度/舒张晚期血流速度( E/A)差异均无统计学意义;而冠心病各组左房增大,差异有统计学意义( P<0.05);②与对照组比较,冠心病各组GLS、GCS均低于对照组( P<0.05);随着Gensini积分的增加,GLS与GCS总体趋势呈进行性降低;③与对照组比较,重度病变组Tssl-SD及Tssl-Diff明显增加( P<0.01);中度病变组Tssl-SD及Tssl-Diff增加(P<0.05);轻度病变组Tssl-SD及Tssl-Diff差异无统计学意义。 Tssc-SD与Tssc-Diff 在两组之间差异无统计学意义;④冠心病组左室收缩同步性与射血分数相关分析:在冠心病组中将不同步性指数与射血分数进行相关性分析,得出Tssl-SD、Tssl-Diff 与 LVEF 均呈显著负相关性。结论2DSTI可准确评价冠心病患者左室心肌收缩功能及收缩同步性,为冠心病患者的早期诊断、治疗方案的选择及减少心血管事件的发生提供一种无创检查方法。
Objective To evaluate left ventricular myocardial strain and myocardial systolic synchrony in patients with different degrees of coronary stenosis by two-dimensional speckle tracking technology (2DSTI).Methods The study included 109 cases of coronary heart disease patients with conventional two-dimensional ultrasounding and speckle tracking .Subjects were divided into control group and coronary heart disease group according to the re -sults of angiography ,while the experimental group was divided into mild disease group ( <25 points), moderate disease group (25~50 points ), and severe disease group (>50 points) on the basis of the Gensini score .Ana-lyzed the high-frequency two-dimensional images with the CMQ software to measure the left ventricular global longi-tudinal strain(GLS) and the left ventricular global circumferential strain (GCS) offline.The time to minimal systol-ic longitudinal,circumferential strain (Tssl,Tssc)was measured from the start point of QRS wave of electrocardio-gram.The left ventricular 16 segments longitudinal and circumferential standard deviation (Tssl-SD, Tssc-SD) and maximal difference ( Tssl-Diff, Tssc-Diff) were calculated , which were in terms of systolic asynchrony indexes .Re-sults ①Compared with the control group , coronary heart disease group of age ,systolic blood pressure , diastolic blood pressure , body mass index ( BMI ) , heart rate , E/A had no statistically significant difference while LA in-creased(P<0.05);②Each group's GLS, GCS of coronary heart disease was lower than the control group (P<0.05 ) .GLS and GCS overall trends showed progressive decrease as Gensini increasing; ③ The severe disease group Tssl-SD and Tssl-Diff significantly increased ( P<0.01 ) when compared with the control group while moder-ate disease group Tssl-SD and Tssl-Diff increased ( P<0.05 ); mild disease group Tssl-SD and Tssl-Diff were not statistically significant .Tssc-SD and Tssc-Diff between the two groups were not statistically significant;④The cor-relation analysis of the coronary heart disease group between the left ventricular systolic synchrony and ejection frac -tion:Tssl-SD, Tssl-Diff negative correlation with LVEF .Conclusion 2DSTI can evaluate coronary artery disease patients'left ventricular systolic function and synchrony accurately , which can be a noninvasive examination method for coronary heart disease ’ s early diagnosis , selection of treatment regimen and can also reduce the incidence of cardiovascular events .