Application of three ⁃ dimensional speckle tracking imaging in the study of left ventricular diastolic function in coronary artery disease
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摘要:
目的：应用三维斑点追踪成像技术(three-dimensional speckle tracking imaging，3D-STI)评估冠心病患者的左心室舒张功能。方法：纳入66例冠心病病例，依据左心室舒张末压(left ventricular end diastolic pressure，LVEDP)分为两组：左室舒张功能正常组(LVEDP≤15 mmHg)31 例，左室舒张功能不全组(LVEDP＞15 mmHg)35 例。另选择 30 例健康志愿者作为对照组。利用4D Auto LVQ软件获取左室心肌17节段的纵向应变(longitudinal strain，LS)、圆周应变(circumferential strain，CS)、面积应变(area strain，AS)及径向应变(radial strain，RS)。结果：左室舒张功能不全组病变心肌4项应变较左室舒张功能正常组及对照组均明显降低(P＜0.05)，左室舒张功能正常组病变心肌LS、AS 较对照组降低(P＜0.05)；Pearson相关分析表明4项应变与LVEDP均有较好的相关性(P＜0.001)；受试者工作特征(receiver operating characteristic，ROC)曲线分析表明4项应变(LS、 CS、AS及RS)预测左心室舒张功能不全的曲线下面积(area under the curve，AUC)分别为0.76、0.76、0.86、0.72(P均＜0.001)。 Logistic 回归分析显示 4 项应变均可作为预测左心室舒张功能不全的风险因子，其 OR 值分别为：LS 9.184(95%CI：1.394~ 30.496，P=0.021)；CS 7.727(95%CI：1.175~20.841，P=0.033)；AS 8.918(95%CI：1.294~19.484，P=0.022)；RS 7.730(95%CI： 1.344~24.438，P=0.026)。结论：3D-STI可用来评估冠心病患者左心室舒张功能，其中LS、AS更有助于发现早期、潜在的左心室舒张功能障碍。
Abstract:
Objective：This study aims to evaluate the left ventricular diastolic function in patients with coronary artery disease by three - dimensional speckle tracking imaging(3D - STI). Methods：Sixty - six patients with coronary heart disease were included and divided into two groups according to left ventricular end diastolic pressure(LVEDP)：31 cases in the group with normal left ventricular diastolic function(LVEDP≤ 15 mmhg)，and 35 cases in the group with left ventricular diastolic dysfunction. Thirty healthy volunteers were selected as the control group. The longitudinal strain(LS)，circumferential strain(CS)，area strain(AS)and radial strain(RS)of 17 segments of left ventricular were obtained by 4D auto LVQ software. Results：Four strains of diseased myocardium in left ventricular diastolic dysfunction group was significantly lower than those in normal left ventricular diastolic function group and control group(P ＜ 0.05)，LS and AS of diseased myocardium in normal left ventricular diastolic function group were lower than those in control group(P ＜ 0.05). Pearson correlation analysis showed that the four strains had good correlation with LVEDP(P ＜ 0.001). The analysis of receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of four strains(LS，CS，AS and RS)predicting left ventricular diastolic dysfunction were 0.76，0.76，0.86 and 0.72 respectively(P ＜ 0.001). Logistic regression analysis revealed that the four strains could be used as risk factors for predicting left ventricular diastolic dysfunction，and their OR values were：LS 9.184(95% CI：1.394~30.496，P=0.021)；CS 7.727(95%CI：1.175~20.841，P=0.033)；AS 8.918(95%CI：1.294~19.484，P=0.022)；RS 7.730 (95%CI：1.344~24.438，P=0.026). Conclusion：3D - STI can be used to evaluate left ventricular diastolic function in patients with coronary artery disease. LS and AS are more useful to find early stage of left ventricular diastolic dysfunction.
