三维面积应变参数预测冠心病患者经皮冠状动脉介入治疗术后心功能改善的价值
| 作者: |
1张建鑫,
1张平洋,
1马小五,
1冉红,
1李妙,
2单守杰
1 南京医科大学附属南京医院，南京市第一医院心血管超声科，南京 210006 2 南京医科大学附属南京医院，南京市第一医院心血管内科，南京 210006 |
| 通讯: |
张平洋
Email: 18951670915@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.10.023 |
| 基金: | 南京市医学科技发展重点项目(ZKX17026)。 |
摘要
目的：应用三维斑点追踪技术(three dimensional speckle tracking imaging，3D- STI)获取冠心病患者行经皮冠状动脉介入治疗(percutaneous coronar y inter vention，PCI)前后左室整体面积应变(global area strain，GAS)参数，并探讨面积应变参数预测PCI术后患者心功能改善的临床应用价值。方法：选取拟行PCI术的42例冠心病患者，分别于术前及术后6个月行常规三维超声心动图及3D- STI检查，记录左室舒张末期容积(end-diastolic volume，EDV)、左室收缩末期容积(end-systolic volume，ESV)、左室射血分数(left ventricular eject fraction，LVEF)、左室GAS值及PCI前后左室射血分数改变量(ΔLVEF)。根据PCI术后LVEF提高率是否≥5%将患者分为心功能改善组与未改善组，比较两组间各参数的差异并探讨面积应变参数与心功能改善间的相关性。结果：PCI术前与术后患者EDV，LVEF，ESV，LVEF，肌钙蛋白含量及GAS差异均无统计学意义(P>0.05)。与未改善组比较，改善组LVEF[(54.9±4.9)% v s (44.3±5.7)%，P<0.001]，GA S[(−31.9±5.8)% vs (−26.0±5.9)%，P=0.003]均明显增高，但肌钙蛋白含量[(1.9±2.0) μg/L vs (4.0±3.4) μg/L]及ESV[(50.6±6.7) mL vs (63.2±10.9) mL]降低。冠心病患者PCI术前GAS与ΔLVEF呈正相关(r=0.58， P<0.001)。以术前GAS预测冠心病患者PCI术后心功能改善(LVEF提高率≥5%)的ROC曲线下面积为0.93，以GAS=28.9%为最佳截断点时敏感度为86.7%，特异度为88.9%。多元线性回归曲线结果显示：GAS(β=−0.73，P<0.001)可作为心功能改善的预测因素。结论：基于3D-STI的面积应变参数与PCI术后患者心功能改变相关，可用于预测冠心病患者PCI术后疗效。
关键词：
三维斑点追踪技术；整体面积应变；左室射血分数；经皮冠状动脉介入治疗
Value of three-dimensional area strain parameters in predicting improvement of left ventricular function after percutaneous transluminal coronary intervention in patients with coronary heart disease
CorrespondingAuthor: ZHANG Pingyang Email: 18951670915@163.com
DOI: 10.3978/j.issn.2095-6959.2019.10.023
Foundation: is work was supported by Nanjing Medical Science and Technology Development Foundation, China (ZKX17026).
Abstract
Objective: To obtain the left ventricular global area strain parameters before and after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD) using three-dimensional speckle tracking imaging (3D-STI), and to investigate the clinical application value of global area strain parameters in predicting cardiac function improvement after PCI. Methods: Forty-two patients with CAD who underwent PCI were enrolled. The following parameters were obtained by routine three-dimensional echocardiography and 3D-STI before and 6 months after surgery: End-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular ejection fraction (LVEF), left ventricular global strain (GAS), and changes in LVEF before and after PCI (ΔLVEF). According to the LVEF improvement rate ≥5% after PCI, the patients were divided into an improved group and an unimproved group. The differences between the two groups were compared and the correlation between area strain parameters and cardiac function improvement was discussed. Results: There were no statistically significant differences in EDV, LVEF, ESV, LVEF, troponin T level and GAS before and after PCI (P>0.05). Compared with the unimproved group, LVEF [(54.9±4.9)% vs (44.3±5.7)%, P<0.001] and GAS [(−31.9±5.8)% vs (−26.0±5.9)%, P=0.003] were significantly higher in the improvep group, but troponin content [(1.9±2.0) μg/L vs (4.0±3.4) μg/L] and ESV [(50.6±6.7) mL vs (63.2±10.9) mL] were decreased. GAS before PCI (preoperative GAS) was positively correlated with ΔLVEF in CAD patients (r=0.58, P<0.001). Preoperative GAS (28.9%) had a sensitivity of 86.7% and a specificity of 88.9% for predicting the improvement of cardiac function (LVEF improvement rate ≥5%) in CAD patients after PCI. Multiple linear regression curves showed that GAS (β=−0.73, P<0.001) could be used as a predictor of cardiac function improvement. Conclusion: The area strain parameters based on 3D-STI were correlated with cardiac function improvement in CAD patients after PCI. It can be used to predict the efficacy of postoperative PCI in patients with coronary heart disease.
Keywords：
three-dimensional speckle tracking; global area strain; left ventricular eject fraction; percutaneous coronary intervention