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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (03) : 169 -177. doi: 10.3877/cma.j.issn.1672-6448.2016.03.003

所属专题： 文献；

心血管超声影像学

三维斑点追踪成像技术评价冠状动脉不同程度狭窄心肌应变
李丹1, 张敏郁2, 高宇2, 王建华1,†(), 汪洪斌2, 王秀玲2   
  1. 1. 100853　北京，解放军医学院
    2. 100700　北京军区总医院超声科
  • 收稿日期:2015-12-08 出版日期:2016-03-01
  • 通信作者: 王建华
  • 基金资助:
    首都临床特色研究基金资助课题(Z121107001012143)

Evaluation of regional myocardial strains in patients with left anterior descending artery stenosis by three-dimensional speckle tracking imaging

Dan Li1, Minyu Zhang2, Yu Gao2, Jianhua Wang1,†(), Hongbin Wang2, Xiuling Wang2   

  1. 1. Chinese People′s Liberation Army Medcial School, Beijing 100853, China
    2. Department of Ultrasound, Beijing Army General Hospital, Beijing 100700, China
  • Received:2015-12-08 Published:2016-03-01
  • Corresponding author: Jianhua Wang
  • About author:
    Corresponding author: Wang Jianhua, Email:
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引用本文：

李丹, 张敏郁, 高宇, 王建华, 汪洪斌, 王秀玲. 三维斑点追踪成像技术评价冠状动脉不同程度狭窄心肌应变[J]. 中华医学超声杂志（电子版）, 2016, 13(03): 169-177.

Dan Li, Minyu Zhang, Yu Gao, Jianhua Wang, Hongbin Wang, Xiuling Wang. Evaluation of regional myocardial strains in patients with left anterior descending artery stenosis by three-dimensional speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 169-177.

目的

应用三维斑点追踪成像（3D-STI）技术评价冠状动脉左前降支（LAD）不同程度狭窄心肌各节段应变。

方法

选取2013年12月至2014年5月北京军区总医院疑诊冠状动脉粥样硬化性心脏病并接受冠状动脉造影的60例患者。根据冠状动脉造影LAD狭窄程度分为：对照组18例（LAD无明确狭窄）、轻度狭窄组（狭窄率≤50%）10例、中度狭窄组（50%<狭窄率≤75%）10例、重度狭窄组（狭窄率>75%）22例。应用3D-STI技术获得LAD供血区域各节段[基底部前壁（BA）、基底部近前间隔壁（BAS）、中部前壁（MA）、中部近前壁间隔壁（MAS）、心尖部前壁（AA）、心尖部间隔壁（AS）、心尖部（A）]应变参数，包括长轴应变（LS）、径向应变（RS）、圆周应变（CS）以及面积应变（AS）。采用单因素方差分析比较4组患者各节段LS、RS、CS、AS差异，进一步组间两两比较采用LSD-t检验。

结果

（1）轻度狭窄组患者各节段LS与对照组患者比较差异均无统计学意义。中度狭窄组患者各节段LS均低于对照组患者，且差异均有统计学意义（t=-7.58、-4.76、-4.38、-4.64、-7.37、-5.00、-7.24，P均<0.05）。中度狭窄组患者AS的LS低于轻度狭窄组患者，且差异有统计学意义（t=-3.73，P<0.05）；其余各节段LS与轻度狭窄组患者比较差异均无统计学意义。重度狭窄组患者各节段LS均低于对照组、轻度狭窄组、中度狭窄组患者，且差异均有统计学意义（重度狭窄组与对照组比较，t=-10.80、-13.96、-13.65、-15.25、-11.11、-11.66、-10.77，P均<0.05；重度狭窄组与轻度狭窄组比较，t=-6.76、-9.96、-9.27、-10.60、-7.45、-8.59、-6.88，P均<0.05；重度狭窄组与中度狭窄组比较，t=-5.23、-8.02、-7.89、-9.01、-6.08、-6.16、-5.49，P均<0.05）。（2）轻度狭窄组患者各节段RS与对照组患者比较差异均无统计学意义。中度狭窄组患者BA的RS与对照组患者比较差异无统计学意义，其余各节段RS均低于对照组患者，且差异均有统计学意义（t=1.16、2.78、3.28、4.86、2.11、4.03，P均<0.05）。中度狭窄组患者各节段RS与轻度狭窄组患者比较差异均无统计学意义。重度狭窄组患者各节段RS均低于对照组、轻度狭窄组患者，且差异均有统计学意义（重度狭窄组与对照组比较，t=4.02、3.26、5.91、5.74、5.92、5.67、5.11，P均<0.05；重度狭窄组与轻度狭窄组比较，t=3.60、2.83、3.96、3.55、3.21、3.31、2.85，P均<0.05），但与中度狭窄组患者比较差异则均无统计学意义。（3）轻度狭窄组患者各节段CS与对照组患者比较差异均无统计学意义。中度狭窄组患者BA、MA的CS与对照组患者比较差异均无统计学意义，其余各节段CS均低于对照组患者，且差异均有统计学意义（t=-6.28、-5.56、-7.37、-4.58、-3.56，P均<0.05）。中度狭窄组患者各节段CS与轻度狭窄组患者比较差异均无统计学意义。重度狭窄组患者各节段CS均低于对照组、轻度狭窄组、中度狭窄组患者，且差异均有统计学意义（重度狭窄组与对照组比较，t=-16.54、-7.58、-12.87、-14.15、-15.93、-14.79、-13.38，P均<0.05；重度狭窄组与轻度狭窄组比较，t=-10.19、-6.28、-6.94、-8.19、-9.59、-9.30、-9.15，P均<0.05；重度狭窄组与中度狭窄组比较，t=-6.20、-3.92、-7.62、-5.21、-6.47、-7.90、-7.56，P均<0.05）。（4）轻度狭窄组患者BA的AS与对照组患者比较差异无统计学意义，其余各节段AS均低于对照组患者，且差异均有统计学意义（t=-4.97、-3.16、-3.52、-4.92、-4.55、-7.32，P均<0.05）。中度狭窄组患者各节段AS均低于对照组患者，且差异均有统计学意义（t=-4.69、-7.00、-4.47、-4.00、-6.60、-4.90、-7.78，P均<0.05）。中度狭窄组患者BA、BAS的AS均低于轻度狭窄组患者，且差异均有统计学意义（t=-1.87、-2.30，P均<0.05）；其余各节段AS与轻度狭窄组患者比较差异均无统计学意义。重度狭窄组患者各节段AS均低于对照组、轻度狭窄组、中度狭窄组患者，且差异均有统计学意义（重度狭窄组与对照组比较，t=-9.19、-14.33、-9.54、-9.41、-11.39、-10.35、-14.19，P均<0.05；重度狭窄组与轻度狭窄组比较，t=-4.51、-7.68、-4.13、-5.19、-3.55、-5.50、-3.62，P均<0.05；重度狭窄组与中度狭窄组比较，t=-2.15、-4.86、-4.55、-4.26、-3.86、-3.71、-3.39，P均<0.05）。

结论

LAD不同程度狭窄心肌各节段的应变降低存在显著差异。3D-STI技术获取的应变参数可用于评价>50%的狭窄。而AS作为一项更敏感的指标，可评价冠状动脉轻度狭窄导致的心肌应变降低。

关键词: 三维斑点追踪成像技术, 冠状动脉狭窄, 心肌应变
Objective

To determine the value of three-dimensional speckle tracking imaging (3D-STI) in diagnosis of coronary artery diseases in patients with stenosis of left anterior descending artery (LAD).

Methods

Sixty patients with clinical possible diagnosis of coronary heart disease (CHD) in Beijing Army General Hospital from December 2013 to May 2014 were enrolled in the study. According to the results of coronary angiography, the patients were divided into four groups: the control group with 18 cases without LAD stenosis, the mild stenosis group (luminal stenosis rate≤50%) with 10 cases, the moderate stenosis group (50%<luminal stenosis rate≤75%) with 10 cases and the severe stenosis group (luminal stenosis rate>75%) with 22 cases. The echocardiographic parameter included long axis strain (LS), radial strain (RS), circumferential strain (CS) and area strain (AS) acquired by 3D-STI in 7 myocardial segments [basis anterior (BA), basis anterior septal (BAS), middle anterior (MA), middle anterior septal (MAS), apex anterior (AA), apex septal (AS), apex (A)] of left ventricle supplied by LAD. The differences of these parameters between the different groups were compared.

Results

(1) Results of LS: the mild stenosis group had no significant difference were observed compared with the control group. LS of moderate stenosis group was significantly lower than that of control group (t=-7.58, -4.76, -4.38, -4.64, -7.37, -5.00 and -7.24, all P<0.05), and part of the segments (AS) LS was significantly lower than that of mild stenosis group (t=-3.73, P<0.05). The other segments LS of moderate stenosis group had no significant difference were observed compared with that of the mild stenosis group. Each segment LS of severe stenosis group was significantly lower than that of control group, the mild stenosis group and moderate stenosis group (severe stenosis group compared with control group, t=-10.80, -13.96, -13.65, -15.25, -11.11, -11.66 and -10.77, all P<0.05; severe stenosis group compared with mild group, t=-6.76, -9.96, -9.27, -10.60, -7.45, -8.59 and -6.88, all P<0.05; severe stenosis group compared with moderate group, t=-5.23, -8.02, -7.89, -9.01, -6.08, -6.16 and -5.49, all P<0.05). (2) Results of RS: the mild stenosis group had no significant difference were observed compared with the control group. BA segment RS of moderate stenosis group has no significant difference were observed compared with that of the control group; the other segments RS was significantly lower than that of control group (t=1.16, 2.78, 3.28, 4.86, 2.11 and 4.03, all P<0.05). RS of moderate stenosis group has no statistical significance difference compared with that of mild stenosis group. Each segment RS of severe stenosis group was significantly lower than that of control group and mild stenosis group (severe stenosis group compared with control group, t=4.02, 3.26, 5.91, 5.74, 5.92, 5.67 and 5.11, all P<0.05; severe stenosis group compared with mild group, t=3.60, 2.83, 3.96, 3.55, 3.21, 3.31 and 2.85, all P<0.05), but the difference compared with moderate stenosis group had no statistical significance. (3) Results of CS: the mild stenosis group had no significant difference were observed compared with the control group. BA and MA segments circumferential strain of moderate stenosis group had no significant difference were observed compared with those of the control group; the other segments CS was significantly lower than that of control group (t=-6.28, -5.56, -7.37, -4.58 and -3.56, all P<0.05), each segment CS in moderate stenosis group has no statistical significance difference compared with that of mild stenosis group. Each segment CS of severe stenosis group was significantly lower than that of control group, the mild stenosis group and moderate stenosis group (severe stenosis group compared with control group, t=-16.54, -7.58, -12.87, -14.15, -15.93, -14.79 and -13.38, all P<0.05; severe stenosis group compared with mild group, t=-10.19, -6.28, -6.94, -8.19, -9.59, -9.30 and -9.15, all P<0.05; severe stenosis group compared with moderate group, t=-6.20, -3.92, -7.62, -5.21, -6.47, -7.90 and -7.56, all P<0.05). (4) Results of AS: BA segment AS of mild stenosis group had no significant difference were observed compared with that of the control group; the other segments AS was significantly lower than that of control group (t=-4.97, -3.16, -3.52, -4.92, -4.55 and -7.32, all P<0.05). Each segmental AS of moderate stenosis group was significantly lower than that of control group (t=-4.69, -7.00, -4.47, -4.00, -6.60, -4.90 and -7.78, all P<0.05), and part of the segments (BA and BAS) was significantly lower than that of mild stenosis group (t=-1.87 and -2.30, both P<0.05), the other segments AS had no significant difference were observed compared with that of the mild stenosis group. The strain of severe stenosis group was significantly lower than that of control group, mild stenosis, and moderate stenosis group (severe stenosis group compared with control group, t=-9.19, -14.33, -9.54, -9.41, -11.39, -10.35 and -14.19, all P<0.05; severe stenosis group compared with mild group, t=-4.51, -7.68, -4.13, -5.19, -3.55, -5.50 and -3.62, all P<0.05; severe stenosis group compared with moderate group, t=-2.15, -4.86, -4.55, -4.26, -3.86, -3.71 and -3.39, all P<0.05).

Conclusion

3D-STI can be used for evaluation of segmental myocardial strains in patients with different stenosis of LAD and AS is a more sensitive parameter for detecting myocardial strain change in mild coronary stenosis.

Key words: Three-dimensional speckle tracking imaging, Coronary stenosis, Myocardial strain
图1 于左心室舒张末期和左心室收缩末期各选取二尖瓣环中点和心尖处心内膜一点，分析软件自动描记出心内膜和心外膜界线
表1 4组冠状动脉狭窄患者临床资料比较（±s）
组别 例数 年龄（岁） 心率（次/min） LVEDV（ml） LVESV（ml） LVEF（%）
对照组 18 61.28±12.25 65.08±8.91 86.02±17.10 36.79±10.37 57.32±8.62
轻度狭窄组 10 60.00±12.06 65.38±7.00 80.22±17.53 35.10±13.87 57.68±7.98
中度狭窄组 10 58.10±5.82 67.51±9.24 102.25±38.49 45.86±36.25 58.36±13.33
重度狭窄组 22 62.55±8.74 62.55±8.74 105.67±28.51a 45.88±18.93 57.59±6.79
F值 ? 0.41 0.34 3.46 1.15 0.03
P值 ? >0.05 >0.05 <0.05 >0.05 >0.05
表2 4组冠状动脉狭窄患者LAD供血心肌各节段LS比较（±s，%）
组别 例数 BA BAS MA MAS AA AS A
对照组 18 -19.17±1.46 -18.83±1.65 -19.28±1.52 -18.39±1.03 -18.44±1.09 -18.11±1.07 -18.33±1.45
轻度狭窄组 10 -17.30±1.76 -17.70±1.37 -18.40±2.01 -17.70±1.25 -17.30±0.94 -17.90±1.19 -16.60±1.43
中度狭窄组 10 -15.00±1.24a -15.90±1.37b -16.70±1.41c -16.40±1.17d -15.60±0.69e -15.90±1.19f -14.60±0.96g
重度狭窄组 22 -7.68±4.3h -8.36±2.80i -9.55±2.68j -9.32±2.33k -8.27±3.74l -10.82±2.46m -7.18±4.18n
F值 ? 59.01 98.17 85.69 117.06 69.09 70.31 60.99
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
表3 4组冠状动脉狭窄患者LAD供血心肌各节段RS比较（±s，%）
组别 例数 BA BAS MA MAS AA AS A
对照组 18 38.94±9.10 34.89±5.36 37.28±3.51 37.72±4.08 35.17±3.94 34.95±3.85 37.39±8.01
轻度狭窄组 10 36.70±4.62 34.80±5.77 37.20±5.59 35.90±4.22 30.60±4.06 33.60±5.14 31.70±2.79
中度狭窄组 10 34.90±9.42 32.80±2.20 a 33.80±2.39b 32.60±1.17c 24.30±7.95d 31.70±3.94e 26.20±4.63f
重度狭窄组 22 29.64±5.35 g 30.68±2.53h 31.32±2.86i 30.95±3.37j 19.05±10.94k 28.95±2.82l 21.77±10.73m
F值 ? 5.75 4.15 11.46 11.78 14.87 9.03 12.68
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
表4 4组冠状动脉狭窄患者LAD供血心肌各节段CS比较（±s，%）
组别 例数 BA BAS MA MAS AA AS A
对照组 18 -19.33±1.02 -20.56±4.24 -23.17±3.22 -20.61±2.25 -19.44±1.14 -19.22±1.35 -19.00±1.13
轻度狭窄组 10 -18.20±1.39 -19.80±4.44 -21.20±5.16 -18.20±2.65 -17.70±1.16 -18.20±1.87 -18.30±1.33
中度狭窄组 10 -16.20±1.61a -17.50±4.74 -20.70±4.16 -15.70±2.21 b -16.00±1.24 c -16.80±1.31d -17.30±1.33e
重度狭窄组 22 -12.68±1.42f -13.09±1.65g -12.59±1.91h -12.32±1.42i -12.32±1.58j -12.32±1.55k -12.55±1.76l
F值 ? 89.51 16.11 36.82 56.99 99.60 77.95 76.61
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
图2~5 三维斑点追踪成像技术测定冠状动脉左前降支不同程度狭窄心肌面积应变。图2~5　分别为对照组、轻度狭窄组、中度狭窄组和重度狭窄组患者面积应变曲线及牛眼图。随着冠状动脉左前降支狭窄程度增加，面积应变逐渐降低，应变曲线表现为杂乱程度逐渐增加，牛眼图表现为蓝色区域面积逐渐增大并且颜色加深
表5 4组冠状动脉狭窄患者LAD供血心肌各节段AS比较（±s，%）
组别 例数 BA BAS MA MAS AA AS A
对照组 18 -28.22±3.45 -31.22±3.85 -34.06±6.21 -32.22±6.05 -30.28±4.02 -32.72±6.18 -30.11±3.37
轻度狭窄组 10 -25.50±5.91 -24.30±2.79a -26.30±6.20b -24.80±3.61c -21.50±5.33d -23.40±2.36e -19.80±3.91f
中度狭窄组 10 -21.10±4.48g -21.30±3.02h -24.80±2.53i -23.70±3.83j -20.90±2.60k -21.90±4.25l -19.40±3.68m
重度狭窄组 22 -17.91±3.58n -15.77±2.95o -19.32±3.38p -18.00±3.35q -15.27±4.23r -16.50±3.60s -14.91±3.36t
F值 ? 22.30 76.29 31.03 33.81 43.13 43.26 63.43
P值 ? <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
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