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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (04) : 293 -300. doi: 10.3877/cma.j.issn.1672-6448.2019.04.011

所属专题: 文献

心血管超声影像学

纵向分层应变技术定量评估左前降支狭窄患者左心室心肌功能
候雪婷1, 李天亮1,(), 胡新玲1, 张晓丽1, 侯跃宏2, 王仲朝3, 司雪霏1, 韩红1   
  1. 1. 030024 太原,山西省心血管病医院超声科
    2. 030024 太原,山西省心血管病医院放射科
    3. 030024 太原,山西省心血管病医院心内科
  • 收稿日期:2017-12-20 出版日期:2019-04-01
  • 通信作者: 李天亮
  • 基金资助:
    山西省重点研发计划项目(201603D321058)

Quantitative assessment of left ventricular myocardial function in patients with left anterior descending branch stenosis by longitudinal stratified strain technique

Xueting Hou1, Tianliang Li1,(), Xinling Hu1, Xiaoli Zhang1, Yuehong Hou2, Zhongchao Wang3, Xuefei Si1, Hong Han1   

  1. 1. Department of Ultrasound, Shanxi Cardiovascular Hospital, Taiyuan 030024, China
    2. Department of Radiology, Shanxi Cardiovascular Hospital, Taiyuan 030024, China
    3. Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030024, China
  • Received:2017-12-20 Published:2019-04-01
  • Corresponding author: Tianliang Li
  • About author:
    Corresponding author: Li Tianliang, Email:
引用本文:

候雪婷, 李天亮, 胡新玲, 张晓丽, 侯跃宏, 王仲朝, 司雪霏, 韩红. 纵向分层应变技术定量评估左前降支狭窄患者左心室心肌功能[J/OL]. 中华医学超声杂志(电子版), 2019, 16(04): 293-300.

Xueting Hou, Tianliang Li, Xinling Hu, Xiaoli Zhang, Yuehong Hou, Zhongchao Wang, Xuefei Si, Hong Han. Quantitative assessment of left ventricular myocardial function in patients with left anterior descending branch stenosis by longitudinal stratified strain technique[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(04): 293-300.

目的

应用心肌纵向分层应变技术评估冠状动脉左前降支(LAD)狭窄患者左心室各层心肌整体和局部收缩功能,并探讨其在早期诊断冠心病(CHD)中的临床应用价值。

方法

选取2016年11月至2017年6月在山西省心血管病医院疑似诊断为冠心病并进一步行冠状动脉造影证实为单纯LAD狭窄的患者123例(病例组),冠状动脉造影证实未见明显狭窄的患者32例(对照组),根据LAD狭窄程度,将病例组分为4组:A组37例(狭窄程度≤30%)、B组27例(30%<狭窄程度≤50%)、C组26例(50%<狭窄程度≤75%)、D组33例(75%<狭窄程度≤100%)。所有患者冠状动脉造影前均进行超声检查,测量常规超声参数以及应变参数。应变参数包括:心内膜下心肌整体纵向应变(GLSendo)、中层心肌整体纵向应变(GLSmid)、心外膜下心肌整体纵向应变(GLSepi)、LAD灌注区域心内膜下心肌区域纵向应变(TLSendo)、中层心肌区域纵向应变(TLSmid)、心外膜下心肌区域纵向应变(TLSepi)、整体纵向应变跨壁梯度?GLS(GLSendo-GLSepi)及区域纵向应变跨壁梯度?TLS(TLSendo-TLSepi)。对各组的纵向分层应变参数进行统计学分析,并绘制各纵向分层应变参数预测LAD狭窄的ROC曲线。

结果

各组内GLSendo、GLSmid、GLSepi及TLSendo、TLSmid、TLSepi均依次递减(P均<0.001);各组间?GLS、?TLS比较,差异无统计学意义(P均>0.05);对照组、A组、B组间各心肌纵向应变参数比较,差异无统计学意义(P均>0.05);与对照组、A组、B组比较,C组GLSendo、GLSepi、TLSendo、TLSmid、TLSepi及D组GLSendo、GLSmid、GLSepi、TLSendo、TLSmid、TLSepi均减低(P均<0.05),且C组与D组的各纵向应变参数比较,差异均有统计学意义(P均<0.05)。TLSendo诊断LAD狭窄(50%<狭窄程度≤75%)的ROC曲线下面积为0.81,截断值为-23.97%时敏感度、特异度分别为61.5%、88.5%;TLSepi诊断LAD狭窄(75%<狭窄程度≤100%)的ROC曲线下面积为0.88,截断值为-16.44%时敏感度、特异度分别为86.8%、81.6%。

结论

心肌纵向分层应变可定量评价冠心病LAD不同狭窄程度患者左心室各层心肌整体和局部收缩功能以及心肌缺血情况,对CHD的早期诊断有一定的价值。

Objective

To evaluate the global and local systolic function of left ventricular myocardium in patients with left anterior descending coronary artery (LAD) stenosis and to explore its clinical value in early diagnosis of coronary heart disease (CHD).

Methods

From November 2016 to June 2017, 123 patients with diagnosed with suspected CHD and confirmed with simple LAD stenosis by coronary angiography (case group) and 32 patients without obvious stenosis (control group) at Shanxi Cardiovascular Hospital were included. According to the results of LAD coronary angiography, the 123 patients were divided into four groups: A (stenosis degree≤30%), B (30%<stenosis degree≤50%), C (50%<stenosis degree≤75%), and D (75%<stenosis degree≤100%). All patients underwent ultrasound examination before coronary angiography, and conventional ultrasound parameters and strain parameters were measured. Strain parameters included global longitudinal strain of the endo-myocardium (GLSendo), global longitudinal strain of the mid-myocardium (GLSmid), global longitudinal strain of the epi-myocardium (GLSepi), territorial longitudinal strain of the endo-myocardium (TLSendo), territorial longitudinal strain of the mid-myocardium (TLSmid), territorial longitudinal strain of the epi-myocardium (TLSepi), global transmural gradient ?GLS (GLSendo-GLSepi), and territorial transmural gradient ?TLS (TLSendo-TLSepi). Statistical analyses were performed to compare the longitudinal stratified strain parameters among groups, and ROC curves were plotted to predict the left anterior descending branch stenosis.

Results

GLSendo, GLSmid, GLSepi, TLSendo, TLSmid, and TLSepi in each group decreased in turn (all P<0.001); there was no significant difference in ?GLS or ?TLS between groups (P>0.05); there was no significant difference in longitudinal strain parameters of the myocardium among the control group, group A, and group B (P>0.05). Compared with the control group, group A, and group B, GLSendo, GLSepi, TLSendo, TLSmid, and TLSepi in group C and GLSendo, GLSmid, GLSepi, TLSendo, TLSmid, and TLSepi in group D decreased (P<0.05), and the longitudinal strain parameters between groups C and D were significantly different (all P<0.05). The area under the ROC curve was 0.81 when TLSendo was used to diagnose LAD stenosis (50%<stenosis degree≤75%), and the sensitivity and specificity were 61.5% and 88.5%, respectively, when the cut-off value was -23.97%. The area under the ROC curve was 0.88 when TLSepi was used to diagnose LAD stenosis (75%<stenosis degree≤100%), and the sensitivity and specificity were 86.8% and 81.6%, respectively, when the cut-off value was -16.44%.

Conclusions

Longitudinal stratified strain technique can quantitatively evaluate the global and regional systolic function of left ventricular myocardium and myocardial ischemia in CHD patients with different degrees of LAD stenosis , and it has appreciated value for the early diagnosis of CHD.

表1 LAD不同狭窄程度的各组患者临床资料比较
表2 LAD不同狭窄程度的各组患者常规超声参数比较(±s
表3 LAD不同狭窄程度的各组患者组内心肌整体纵向分层应变参数比较(%,±s
表4 LAD不同狭窄程度的各组患者组内心肌区域纵向分层应变参数比较(%,±s
图1 冠状动脉左前降支狭窄患者(75%<狭窄程度≤100%)左心室17节段纵向分层应变牛眼图及3层心肌整体纵向应变图
表5 LAD不同狭窄程度的各组患者组间心肌整体及区域纵向分层应变参数比较(%,±s
图2 各纵向分层应变参数预测冠状动脉左前降支狭窄(50%<狭窄程度≤75%)的ROC曲线图。图a为整体纵向应变参数的ROC曲线;图b为区域纵向应变参数的ROC曲线
图3 各纵向分层应变参数预测冠状动脉左前降支狭窄(75%<狭窄程度≤100%)的ROC曲线图。图a为整体纵向应变参数的ROC曲线;图b为区域纵向应变参数的ROC曲线
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