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目的探讨左心室三维应变在预测冠心病患者冠状动脉狭窄程度中的临床应用价值。方法行冠状动脉造影(coronary artery angiography,CAG)患者121例,依据CAG结果分为CAG阳性组和CAG阴性组;CAG检查前患者均应用三维斑点追踪技术行超声心动图检查,比较2组左心室三维节段纵向应变(three-dimensional segmental longitudinal strain,3D-LSS)、左心室三维节段面积应变(three-dimensional segmental area strain,3D-ASS)、左心室三维节段圆周应变(three-dimensional segmental circumferential strain,3D-CSS)及左心室三维节段径向应变(three-dimensional segmental radial strain,3D-RSS);绘制ROC曲线,分析左心室三维应变指标预测CAG阳性、冠状动脉中重度狭窄的价值。结果CAG阳性组左前降支、左回旋支及右冠状动脉|3D-LSS|[(18.2±2.6)%、(18.6±2.1)%、(17.7±3.1)%]低于CAG阴性组[(21.2±3.1)%、(21.7±2.8)%、(20.7±2.7)%],|3D-ASS|[(27.3±6.3)%、(26.1±5.7)%、(26.2±8.1)%]低于CAG阴性组[(33.6±7.2)%、(34.2±6.9)%、(32.8±6.9)%],差异均有统计学意义(P<0.05);2组左前降支、左回旋支及右冠状动脉|3D-CSS|与3D-RSS比较差异无统计学意义(P>0.05);ROC曲线分析结果显示,左心室3D-LSS(截点值=-17%)和3D-ASS(截点值=-27%)预测CAG阳性的灵敏度、特异度和AUC分别为55.2%、74.1%、0.702和61.2%、72.2%、0.692;左心室3D-LSS(截点值=-17%)和3D-ASS(截点值=-27%)预测冠状动脉中重度狭窄的灵敏度、特异度和AUC分别为71.9%、81.3%、0.817和76.7%、82.9%、0.809。结论 3D-LSS和3D-ASS对冠心病预测有一定价值,在预测冠状动脉中重度狭窄中有较高的灵敏度和特异度。
Objective To investigate the clinical value of three-dimensional left ventricular strain in predicting the degree of coronary artery stenosis in patients with coronary heart disease. Methods 121 patients with coronary artery angiography (CAG) were divided into CAG-positive group and CAG-negative group according to CAG results. Before CAG, all patients were examined by echocardiography with three-dimensional speckle tracking. The left ventricular Dimensional three-dimensional segmental longitudinal strain (3D-LSS), left ventricular three-dimensional segmental area strain (3D-ASS), left ventricular three-dimensional segmental strain (3D-RSS). The ROC curve was drawn to analyze the value of three-dimensional strain index of left ventricle in predicting CAG positive and moderate-severe coronary artery stenosis . Results | 3D-LSS | [(18.2 ± 2.6)%, (18.6 ± 2.1)%, (17.7 ± 3.1)%] in the CAG positive group were significantly lower than those in the CAG negative group [(21.2 (27.3 ± 6.3)%, (26.1 ± 5.7)%, (26.2 ± 8.1)%] were significantly lower than that of CAG (± 3.1%, 21.7 ± 2.8% and 20.7 ± 2.7%, respectively) (33.6 ± 7.2)%, (34.2 ± 6.9)%, (32.8 ± 6.9)%, respectively, with significant difference (P <0.05). The left anterior descending branch, the left circumflex branch and the right coronary artery (P> 0.05). The ROC curve analysis showed that left ventricular 3D-LSS (cutoff = -17%) and 3D-ASS (cutoff = -27%) showed a sensitivity, specificity and AUC of 55.2%, 74.1%, 0.702 and 61.2%, 72.2% and 0.692 respectively for predicting positive CAG; left ventricular 3D-LSS (Cutoff = -27%) had a sensitivity, specificity, and AUC of 71.9%, 81.3%, 0.817 and 76.7%, 82.9% and 0.809, respectively, for predicting moderate to severe coronary artery stenosis. Conclusion 3D-LSS and 3D-ASS have some value in predicting coronary heart disease, and have higher sensitivity and specificity in predicting moderate-severe coronary artery stenosis.