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目的探讨应变率成像(SRI)评价多巴酚丁胺负荷试验(DSE)中缺血心肌的舒张功能变化。方法选取20例冠心病患者和30例健康对照者,测量左心室前壁及前间隔心肌的应变率(SR)指标。结果正常组舒张早期SR随负荷剂量的增加而增大,与静息状态下比较差异有统计学意义(P<0.05)。冠心病组舒张早期SR在小剂量10、20μg.kg-1.min-1时测值增加(P<0.05),大剂量30、40μg.kg-1.min-1时测值降低,与正常组同一负荷阶段相比差异有统计学意义。缺血心肌收缩后收缩的检出率明显高于正常心肌(χ2=6.315,P<0.05)。舒张早期峰值SR在30μg.kg-1.min-1时检测的敏感性和特异性分别为88%和92%。结论缺血心肌的舒张早期峰值SR降低,是反映局部舒张功能变化敏感而特异的指标,收缩后收缩可评价局部心肌舒张功能。
Objective To investigate the changes of diastolic function in ischemic myocardium by strain rate imaging (SRI) in dobutamine stress test (DSE). Methods Twenty patients with coronary heart disease and 30 healthy controls were selected to measure the strain rate (SR) index of anterior wall of left ventricle and anterior septal myocardium. Results In the normal group, the early diastolic SR increased with the increase of the loading dose, which was significantly different from that at rest (P <0.05). The early diastolic SR in coronary heart disease group was significantly increased at low dose of 10, 20μg.kg-1.min-1 (P <0.05), and decreased at high dose of 30,40μg.kg-1.min-1 The same load phase compared with the difference was statistically significant. The detection rate of contractile contraction of ischemic myocardium was significantly higher than that of normal myocardium (χ2 = 6.315, P <0.05). The sensitivity and specificity for the detection of SR at 30 μg.kg-1 .min-1 at early diastolic peak were 88% and 92%, respectively. Conclusions The early diastolic peak SR of ischemic myocardium is a sensitive and specific index reflecting the change of local diastolic function. The systolic contraction can be used to evaluate the local diastolic function.