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目的应用二维斑点追踪成像技术(2D-STI)评价不同程度冠状动脉狭窄对左心室功能的影响,探讨临床诊断价值。方法选取门诊或住院治疗可疑冠心病(CHD)患者146例,采用标准Judkins法行冠状动脉造影。根据冠状动脉造影结果分为4组:正常对照组、轻度狭窄组、中度狭窄组和重度狭窄组。应用2D-STI获取左心室整体纵向应变(LS)、径向应变(RS)及圆周应变(CS)。通过绘制受试者工作特征曲线(ROC)评价不同程度冠状动脉狭窄检出的灵敏度和特异度,探讨2DSTI技术在冠心病诊断中的临床价值。结果与对照组比较,轻度狭窄组LS、RS、CS均无统计学意义(P>0.05),中度狭窄组较对照组、轻度狭窄组LS降低(P<0.05),重度狭窄组较对照组LS、RS、CS均降低(P<0.05),且随着冠状动脉病变程度的加重,LS进行性减小。ROC曲线表明以LS为-17.8作为筛选中度狭窄组的截断值,其诊断灵敏度为57.7%、特异度59.6%,AUC=0.59;以LS为-16.8作为筛选重度狭窄组的截断值时诊断价值最佳,其诊断灵敏度为84.6%、特异度为83.3%,AUC=0.85。结论 CHD患者左心室收缩功能均有不同程度受损,且随狭窄程度增加而加重,尤其在重度狭窄组尤为显著。2D-STI可以定量评价冠状动脉狭窄患者的左心室应变,为早期客观预测冠脉病变程度及评估CHD患者左心室功能提供了一个无创、准确、简便的新途径。
Objective To evaluate the effect of different degrees of coronary artery stenosis on left ventricular function using 2D speckle tracking imaging (2D-STI) to explore the value of clinical diagnosis. Methods Outpatient or hospitalized patients with suspected coronary heart disease (CHD) 146 cases, using standard Judkins method of coronary angiography. According to coronary angiography results were divided into 4 groups: normal control group, mild stenosis group, moderate stenosis group and severe stenosis group. The left ventricular longitudinal strain (LS), radial strain (RS) and circumferential strain (CS) were obtained by 2D-STI. The sensitivity and specificity of different degrees of detection of coronary artery stenosis were evaluated by plotting the receiver operating characteristic curve (ROC) to explore the clinical value of 2DSTI in the diagnosis of coronary heart disease. Results Compared with the control group, LS, RS and CS in mild stenosis group were not statistically significant (P> 0.05). LS in moderate stenosis group was lower than that in control group and mild stenosis group (P <0.05) The levels of LS, RS and CS in control group decreased (P <0.05), and LS decreased progressively with the severity of coronary artery disease. The ROC curve showed that the diagnostic sensitivity was 57.7%, the specificity was 59.6% and the AUC was 0.59 with LS of -17.8 as the cut-off value of screening the moderate stenosis group. The best diagnostic sensitivity was 84.6%, specificity was 83.3%, AUC = 0.85. Conclusion The left ventricular systolic function in patients with CHD is impaired to varying degrees and increases with the degree of stenosis, especially in severe stenosis group. 2D-STI can quantitatively evaluate the left ventricular strain in patients with coronary artery stenosis. It provides a new noninvasive, accurate and convenient way to objectively predict the extent of coronary lesions and evaluate left ventricular function in patients with CHD.