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目的应用三维斑点追踪成像(3D-STI)技术评价不同狭窄程度的冠心病患者左心室扭转运动,并分析扭转运动与冠心病的关系。方法 346例研究对象(其中冠心病患者204例)依冠状动脉狭窄程度分为轻度病变组、中度病变组、重度病变组、闭塞病变组、正常对照组,应用3D-STI技术获得左室整体、基底段、心尖段扭转角度峰值(PAR、PBR、Ptw)及扭转角度达峰时间(PART、PBRT、PtwT)、左室射血分数(LVEF)等指标,比较各组之间上述指标的差异,评估各指标与冠状动脉狭窄程度关系及对冠状动脉病变的预测价值。结果闭塞病变组与正常组和轻度病变组比较PART、PBRT、PtwT延长而PAR、PBR、Ptw减低,差异有统计学意义(均P<0.01);重度病变组与正常组和轻微狭窄组比较PART、PBRT延长而PAR、Ptw减小,差异有统计学意义(P<0.01)。冠心病患者左心室扭转参数与冠状动脉狭窄率呈正相关(r=0.465、0.23、0.27、0.537、0.19、0.24,P<0.01);Ptw诊断冠状动脉重度狭窄的ROC曲线下面积为0.655±0.029,以Ptw值11°作为检测冠状动脉重度狭窄的截断值时,其灵敏度为60.6%、特异度为51.7%。结论应用3D-STI技术能够评价冠心病患者的左心室扭转功能,对冠心病的诊断也有一定价值。
Objective To evaluate left ventricular (LV) torsion in patients with coronary heart disease with different stenosis by 3D speckle tracking imaging (3D-STI) and to analyze the relationship between torsion and coronary heart disease. Methods 346 patients (including 204 patients with coronary heart disease) were divided into mild lesion group, moderate lesion group, severe lesion group, occlusion lesion group and normal control group according to the degree of coronary artery stenosis. Left ventricular (PAR, PBR, Ptw), peak of torsion angle (PART, PBRT, PtwT) and left ventricular ejection fraction (LVEF) in the whole, basal segment, apical segment, Differences, assessment of the relationship between the indicators and the degree of coronary artery stenosis and its predictive value of coronary artery disease. Results The PAR, PBRT and PtwT in the occlusion group were longer than those in the normal group and the mild group, while PAR, PBR and Ptw were decreased (all P <0.01). Compared with the normal group and the mild group PART, PBRT prolonged while PAR, Ptw decreased, the difference was statistically significant (P <0.01). Coronary heart disease in patients with left ventricular torsion parameters and coronary stenosis rate was positively correlated (r = 0.465,0.23,0.27,0.537,0.19,0.24, P <0.01); Ptw diagnosis of severe coronary artery stenosis area under the ROC curve was 0.655 ± 0.029, The Ptw value of 11 ° as the detection of severe coronary artery stenosis cut-off value, the sensitivity was 60.6%, the specificity was 51.7%. Conclusions The application of 3D-STI technique can evaluate the left ventricular function in patients with coronary heart disease, and has some value in the diagnosis of coronary heart disease.