【摘要】：目的應(yīng)用超聲速度向量成像技術(shù)(VVI)探討冠心病左前降支(LAD)病變患者左室局部收縮功能與冠狀動脈病變程度的關(guān)系,為臨床客觀評價(jià)節(jié)段性室壁運(yùn)動提供一種較好的方法。方法根據(jù)冠狀動脈造影結(jié)果,左心室心肌分為正常組20例、缺血組20例和梗死組20例,所有受檢者于超聲心動圖中取心尖四腔心、兩腔心、心尖左室長軸切面,二尖瓣水平及乳頭肌水平及心尖水平左室短軸切面的18個(gè)節(jié)段的心肌動態(tài)圖像,對僅由冠狀動脈LAD供血的相應(yīng)左室壁節(jié)段徑向應(yīng)變、圓周應(yīng)變、縱向應(yīng)變,心底水平及心尖水平前壁及前間隔的收縮期旋轉(zhuǎn)角度及旋轉(zhuǎn)速率進(jìn)行分析。結(jié)果缺血組及梗死組的前壁及前間隔基底段、中間段、心尖段的收縮期縱向、圓周、徑向應(yīng)變均較正常組減低,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。當(dāng)患者左室射血分?jǐn)?shù)正常并常規(guī)二維超聲心動圖檢查未見節(jié)段性室壁運(yùn)動異常時(shí),前壁、前間隔任意水平縱向應(yīng)變-17.58%、圓周應(yīng)變-20.52%,徑向應(yīng)變36.26%作為預(yù)測前降支病變引起心肌缺血的截?cái)嘀?可獲得最佳敏感度及特異度。當(dāng)患者左室射血分?jǐn)?shù)正常且靜息時(shí)超聲心動圖檢查前降支供血相應(yīng)區(qū)域有明顯節(jié)段性室壁運(yùn)動異常時(shí),前壁、前間隔任意水平縱向應(yīng)變-15.86%、圓周應(yīng)變-18.30%,徑向應(yīng)變34.60%作為預(yù)測前降支病變引起心肌梗死的截?cái)嘀?可獲得最佳敏感度及特異度。梗死組前間隔、前壁心肌收縮期旋轉(zhuǎn)角度及旋轉(zhuǎn)速率在心底及心尖水平均低于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),缺血組缺血節(jié)段的收縮期旋轉(zhuǎn)角度及旋轉(zhuǎn)速率在心尖水平及在心底水平與正常組相比,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論當(dāng)冠心病患者左室射血分?jǐn)?shù)正常并常規(guī)二維超聲心動圖檢查未見節(jié)段性室壁運(yùn)動異常時(shí),VVI技術(shù)測量其狹窄冠脈供血區(qū)域心肌已出現(xiàn)局部收縮功能減低。對于LAD患者,應(yīng)用VVI技術(shù)測量前間隔及前壁各水平心肌縱向、圓周應(yīng)變能較好鑒別靶血管病變程度,并能定位冠心病患者的缺血節(jié)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.
【作者單位】： 廣東醫(yī)科大學(xué)附屬醫(yī)院超聲科;
【基金】：湛江市科技攻關(guān)計(jì)劃項(xiàng)目(編號:2015B01073)
【分類號】：R540.45;R541.4

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