速度向量成像在定量评价冠状动脉左前降支病变患者左室壁运动中的应用

发布时间：2018-07-22 15:44

【摘要】：目的应用超声速度向量成像技术(VVI)探讨冠心病左前降支(LAD)病变患者左室局部收缩功能与冠状动脉病变程度的关系,为临床客观评价节段性室壁运动提供一种较好的方法。方法根据冠状动脉造影结果,左心室心肌分为正常组20例、缺血组20例和梗死组20例,所有受检者于超声心动图中取心尖四腔心、两腔心、心尖左室长轴切面,二尖瓣水平及乳头肌水平及心尖水平左室短轴切面的18个节段的心肌动态图像,对仅由冠状动脉LAD供血的相应左室壁节段径向应变、圆周应变、纵向应变,心底水平及心尖水平前壁及前间隔的收缩期旋转角度及旋转速率进行分析。结果缺血组及梗死组的前壁及前间隔基底段、中间段、心尖段的收缩期纵向、圆周、径向应变均较正常组减低,且差异有统计学意义(P0.05)。当患者左室射血分数正常并常规二维超声心动图检查未见节段性室壁运动异常时,前壁、前间隔任意水平纵向应变-17.58%、圆周应变-20.52%,径向应变36.26%作为预测前降支病变引起心肌缺血的截断值,可获得最佳敏感度及特异度。当患者左室射血分数正常且静息时超声心动图检查前降支供血相应区域有明显节段性室壁运动异常时,前壁、前间隔任意水平纵向应变-15.86%、圆周应变-18.30%,径向应变34.60%作为预测前降支病变引起心肌梗死的截断值,可获得最佳敏感度及特异度。梗死组前间隔、前壁心肌收缩期旋转角度及旋转速率在心底及心尖水平均低于正常组,差异有统计学意义(P0.05),缺血组缺血节段的收缩期旋转角度及旋转速率在心尖水平及在心底水平与正常组相比,差异均无统计学意义(P0.05)。结论当冠心病患者左室射血分数正常并常规二维超声心动图检查未见节段性室壁运动异常时,VVI技术测量其狭窄冠脉供血区域心肌已出现局部收缩功能减低。对于LAD患者,应用VVI技术测量前间隔及前壁各水平心肌纵向、圆周应变能较好鉴别靶血管病变程度,并能定位冠心病患者的缺血节段心肌。
[Abstract]:Objective to investigate the relationship between left ventricular regional systolic function and coronary artery disease in patients with left anterior descending coronary artery disease (lad) by using velocity vector imaging (VVI), and to provide a better method for the objective evaluation of segmental ventricular wall motion. Methods according to the results of coronary angiography, left ventricular myocardium was divided into normal group (n = 20), ischemic group (n = 20) and infarction group (n = 20). Myocardial dynamic images of 18 segments of left ventricular short axis section at mitral valve level, papillary muscle level and apical level were performed on the corresponding left ventricular wall radial strain, circumferential strain, longitudinal strain only supplied by coronary lad. The systolic rotation angle and rotation rate of anterior wall and anterior septum were analyzed. Results the longitudinal, circumferential and radial strain of anterior wall and anterior septal basal segment, middle segment and apical segment in ischemic group and infarction group were lower than those in normal group (P0.05). When the left ventricular ejection fraction was normal and the segmental wall motion was not detected by conventional two-dimensional echocardiography, the anterior wall, The optimal sensitivity and specificity could be obtained by using longitudinal strain -17.58 at any level of anterior septum, circumferential strain -20.52 and radial strain of 36.26% to predict the truncation value of myocardial ischemia caused by anterior descending branch disease. When the left ventricular ejection fraction was normal and resting, the anterior wall was found to have obvious segmental wall motion abnormality in the corresponding region of anterior descending branch by echocardiography. The optimal sensitivity and specificity could be obtained by predicting the truncation value of myocardial infarction caused by anterior descending artery disease by using longitudinal strain -15.86 at any level of anterior septum, circumferential strain -18.30 and radial strain 34.60%. The rotation angle and rotation rate of anterior septum and anterior wall in infarct group were lower than those in normal group. The difference was statistically significant (P0.05). There was no significant difference in systolic rotation angle and rotation rate between ischemic group and normal group (P0.05). Conclusion when left ventricular ejection fraction (LVEF) in patients with coronary heart disease (CHD) is normal and there is no segmental ventricular wall motion abnormality detected by conventional two-dimensional echocardiography, the regional systolic function has been decreased by VVI technique in patients with coronary artery stenosis. For lad patients, VVI technique was used to measure the longitudinal myocardium of anterior septum and anterior wall. The circumferential strain could distinguish the degree of target vascular lesion and localize the ischemic myocardium of coronary heart disease patients.
【作者单位】：广东医科大学附属医院超声科;
【基金】：湛江市科技攻关计划项目(编号:2015B01073)
【分类号】：R540.45;R541.4

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