探讨斑点追踪成像技术对冠心病的早期诊断价值
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摘要
目的
应用二维斑点追踪成像(STI)技术对常规方法显示室壁运动正常的冠心病患者进行应变和应变率的定量分析,探讨其在诊断冠心病中的临床应用价值。
方法
采集经冠状动脉造影或CT证实的40例冠心病和40例对照组患者的心尖长轴、四腔和两腔观的二维灰阶动态图像,测量舒张早期峰值应变率(SrE)和舒张晚期峰值应变率(SrA)以及整体长轴平均应变(GLPS-Avg),应用受试者工作特征曲线(ROC)评价左室壁各节段SrE/SrA<1的比例以及GLPS-Avg对筛选冠心病的敏感性和特异性以及二者在对评估冠脉病变程度时的应用价值。
结果
舒张期应变率:冠心病组室壁各节段中SrE/SrA<1的比例明显增加,以SrE/SrA<1的比例≥23.6%(AUC=0.614)作为临界值(cut-off value),其诊断冠心病的敏感性和特异性分别为47.5%、72.5%;以SrE/SrA<1的比例≥30.5%(AUC=0.739)作为临界值,诊断冠心病多支病变的敏感性为56.0%,特异性为80.0%;以SrE/SrA<1比例≥26.4%(AUC=0.701)作为筛选冠脉狭窄(>50%)的冠心病患者的临界值,其敏感性为56.7%,特异性为78.0%;
整体长轴平均应变:冠脉组较正常组的GLPS-Avg减低(数值),差异有统计学意义(p<0.05),以GLPS-Avg≤-20.7%(AUC=0.777)作为筛选冠心病的临界值,其敏感性为87.5%,特异性为60.0%;以GLPS-Avg为≤-19.7%(AUC=0.790)作为筛选狭窄(>50%)的冠心病的临界值,其敏感性为73.3%,特异性为76.0%。
两种方法结合:以符合任意一项方法的判断标准作为筛选冠心病狭窄(>50%)的标准(室壁SrE/SrA<1比例≥26.4%或GLPS-Avg≤-19.7%),其敏感性和特异性分别为76.7%、68.0%;同时满足两种方法(室壁SrE/SrA<1比例≥26.4%且GLPS-Avg≤-19.7%)作为筛选冠心病狭窄的标准,其敏感性和特异性分别为46.7%、84.0%。
结论
STI技术检查中,SrE/SrA<1的比例在冠心病患者中较正常人增高;GLPS-Avg均数大小在冠心病患者中较正常人减低,且均与病变程度有关,将二者结合起来,可使筛选冠心病的诊断准确率增高。
Objective
To investigate the clinical value of speckle tracking imaging in the diagnosis of myocardial ischemia with normal ventricular wall motion.
Methods
According to the results of coronary angiography or CT, 40 patients with coronary heart disease(CHD)and 40 age-matched subjects were erolled.The two dimensional loop-cinec were obtained in apical 4-chamber view,apical 2-chamber view and long asix of left ventricle view. The parameters, including early strain rate(SrE)and late stain rate(SrA)of diastolic phase and average globe longitudinal strain ( GLS_Avg ) , were measured and calculated. Incidence of SrE/SrA<1 and GLPS_Avg were applied to evaluate the diagnostic efficiency for CHD by receiver operating curve.
Results
Diastolic strain rate : The incidence of(SrE/SrA<1)in CHD group was significantly higher than that in control group(p<0.01).The cutoff values of incidence of SrE/SrA<1 to diagnose CHD and multi-coronary heart disease were 23.6%and 30.5% respectively,with the sensitivity 47.5% and 56.0%as well as specificity 72.5%and 80.0%. the cutoff value of incidence of SrE/SrA<1 to diagnose CHD with at least one coronary artery stenosis≥50% was26.4% ,with the sensitivity 56.7% and specificity 78.0%.
Averge globe longtitude strain: GLPS_Avg in CHD was significantly decreased. The cutoff values of GLPS_Avg to diagonos CHD and CHD with at least one coronary artery stenosis≥50% were -20.7% and -19.7% respectively, with the sensitivity 87.5%and 73.3% as well as specificity 60.0%and 76.0%.
The combination of two methods: Either of the standards ( the incidence of(SrE/SrA<1)≥26.4% or GLPS_Avg≤-19.7%) was met , the sensitivity and the specificity to diagnose CHD was 76.7% and 68.0% respectively. And the two standards were met simultaneously, with sensitivity of 46.7%and specificity of 84.0%.
Conclusions
Increased incidence of SrE/SrA<1 or decreased GLPS-Avg with STI technique was helpful to diagnose CHD. The accuracy to diagnosis of CHD will increase if the two methods were combined .
应用二维斑点追踪成像(STI)技术对常规方法显示室壁运动正常的冠心病患者进行应变和应变率的定量分析,探讨其在诊断冠心病中的临床应用价值。
方法
采集经冠状动脉造影或CT证实的40例冠心病和40例对照组患者的心尖长轴、四腔和两腔观的二维灰阶动态图像,测量舒张早期峰值应变率(SrE)和舒张晚期峰值应变率(SrA)以及整体长轴平均应变(GLPS-Avg),应用受试者工作特征曲线(ROC)评价左室壁各节段SrE/SrA<1的比例以及GLPS-Avg对筛选冠心病的敏感性和特异性以及二者在对评估冠脉病变程度时的应用价值。
结果
舒张期应变率:冠心病组室壁各节段中SrE/SrA<1的比例明显增加,以SrE/SrA<1的比例≥23.6%(AUC=0.614)作为临界值(cut-off value),其诊断冠心病的敏感性和特异性分别为47.5%、72.5%;以SrE/SrA<1的比例≥30.5%(AUC=0.739)作为临界值,诊断冠心病多支病变的敏感性为56.0%,特异性为80.0%;以SrE/SrA<1比例≥26.4%(AUC=0.701)作为筛选冠脉狭窄(>50%)的冠心病患者的临界值,其敏感性为56.7%,特异性为78.0%;
整体长轴平均应变:冠脉组较正常组的GLPS-Avg减低(数值),差异有统计学意义(p<0.05),以GLPS-Avg≤-20.7%(AUC=0.777)作为筛选冠心病的临界值,其敏感性为87.5%,特异性为60.0%;以GLPS-Avg为≤-19.7%(AUC=0.790)作为筛选狭窄(>50%)的冠心病的临界值,其敏感性为73.3%,特异性为76.0%。
两种方法结合:以符合任意一项方法的判断标准作为筛选冠心病狭窄(>50%)的标准(室壁SrE/SrA<1比例≥26.4%或GLPS-Avg≤-19.7%),其敏感性和特异性分别为76.7%、68.0%;同时满足两种方法(室壁SrE/SrA<1比例≥26.4%且GLPS-Avg≤-19.7%)作为筛选冠心病狭窄的标准,其敏感性和特异性分别为46.7%、84.0%。
结论
STI技术检查中,SrE/SrA<1的比例在冠心病患者中较正常人增高;GLPS-Avg均数大小在冠心病患者中较正常人减低,且均与病变程度有关,将二者结合起来,可使筛选冠心病的诊断准确率增高。
Objective
To investigate the clinical value of speckle tracking imaging in the diagnosis of myocardial ischemia with normal ventricular wall motion.
Methods
According to the results of coronary angiography or CT, 40 patients with coronary heart disease(CHD)and 40 age-matched subjects were erolled.The two dimensional loop-cinec were obtained in apical 4-chamber view,apical 2-chamber view and long asix of left ventricle view. The parameters, including early strain rate(SrE)and late stain rate(SrA)of diastolic phase and average globe longitudinal strain ( GLS_Avg ) , were measured and calculated. Incidence of SrE/SrA<1 and GLPS_Avg were applied to evaluate the diagnostic efficiency for CHD by receiver operating curve.
Results
Diastolic strain rate : The incidence of(SrE/SrA<1)in CHD group was significantly higher than that in control group(p<0.01).The cutoff values of incidence of SrE/SrA<1 to diagnose CHD and multi-coronary heart disease were 23.6%and 30.5% respectively,with the sensitivity 47.5% and 56.0%as well as specificity 72.5%and 80.0%. the cutoff value of incidence of SrE/SrA<1 to diagnose CHD with at least one coronary artery stenosis≥50% was26.4% ,with the sensitivity 56.7% and specificity 78.0%.
Averge globe longtitude strain: GLPS_Avg in CHD was significantly decreased. The cutoff values of GLPS_Avg to diagonos CHD and CHD with at least one coronary artery stenosis≥50% were -20.7% and -19.7% respectively, with the sensitivity 87.5%and 73.3% as well as specificity 60.0%and 76.0%.
The combination of two methods: Either of the standards ( the incidence of(SrE/SrA<1)≥26.4% or GLPS_Avg≤-19.7%) was met , the sensitivity and the specificity to diagnose CHD was 76.7% and 68.0% respectively. And the two standards were met simultaneously, with sensitivity of 46.7%and specificity of 84.0%.
Conclusions
Increased incidence of SrE/SrA<1 or decreased GLPS-Avg with STI technique was helpful to diagnose CHD. The accuracy to diagnosis of CHD will increase if the two methods were combined .
引文
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2.周永昌,郭万学·超声医学·第4版·北京:科学技术文献出版社,2002·256-278.
3.王新房·超声心动图学·第4版·北京:人民卫生出版社,2009·132-134.
4. Foster E , Lease KE. New untwist on diastole:what goes around comes back.Circulation,2006,113(21):2477-2479.
5.白云艳,董晓秋,连杰.心肌应变定量评价管家动脉支架置入术后梗死心肌局部功能研究.中国超声医学杂志,2009,25(9):873-875.
6. Willianms RI, Payne N, Phillips T,et al. Strain rate imaging after dynamic stress provides objects evidence of persistent regional myocardial dysfunction in ischaemic myocardium:regional stuning identified. Heart, 2005,91(2):152-160.
7. Viogt JU,Exner B,Schmiedehausen K, et al. Strain rate imaging during dobutamine stress echocardiography provides objective evidence of inducibe ischemia. Circulation,2003,107(4):2120-2126.
8. Brage H,Amundsen MD,Thomas Helle-Valle et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography. J Am Coll Cardiol, 2006,47(4): 789-793.
9. Pirat B, Khoury DS, Hartley CJ, et al. A novel feature-tracking echocardiograpic method for the quantitation of regional myocardial function:validation in an animal model of ischemia-reperfusion. J Am Coll Cardiol. 2008,51(8):651-659.
10.沈燕华,贺声,高云华,等.二维应变对正常冠心病的应用研究.中国超声医学杂志, 2009,25(11):1041-1044.
11. Winter R, Jussila R , Nowak J, et al. Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia:a pilot study from the catheterization laboratory during percutaneous coronary intervention. J Am Soc Echocardiogr ,2007,20(12):974-981.
12. Liang HY, Cauduro S, Pellikka P, et al. Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. J Am Coll Cardiol,2006,98(24):1581-1586.
13. Sun JP, Niu JL, Chou D, et al. Alterations of regional myocardial function in a swine model of myocardial infarction assessed by echocardiographic 2-dimensional strain imaging. J Am Soc Echocardiogr,2007,20(5):498-504.
14. Bertini M, Ng AC, Borleffs CJ,et al.Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy.Am Heart J,2010,160(12):729-736.
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