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目的:探讨与组织多普勒成像(TDI)技术相比,应用二维斑点追踪成像(2D-STI)评价左室心肌纵向节段应变性(STR)的可靠性。方法:选择健康志愿者35例,应用2D-STI和TDI技术分别测量左心室前壁、侧壁、后壁、下壁、室间隔及前间隔的基底段、中段及心尖段共18个节段心肌的纵向STR,观察其规律性。然后从35例志愿者中随机抽取10例,应用上述两种技术由同一观察者分别测量两次、再由两名观察者测量1次左室各壁基底段STR,对其测值进行变异系数、相关系数、平均差值等比较。结果:(1)2D-STI检测显示,STR基底段<中段<心尖段;TDI检测显示STR基底段>中段及心尖段。两种方法测得的部分相同室壁不同节段的STR值差异有统计学意义(P<0.05或P<0.01),不同室壁相同节段的STR值差异无统计学意义(P>0.05)。(2)应用2D-STI测出的左室各壁基底段、中段、心尖段STR的变异系数均较TDI测出值低(分别为-0.25、-0.23、-0.26 vs-0.33、-0.35、-0.40)。(3)同一观察者可靠性:两次应用2D-STI法测得各室壁基底段的STR值差异无统计学意义(P=0.86),两次STR值的相关系数为0.73(P<0.001),两次STR值的平均差值为(-0.00±3.19)%。两次应用TDI法测得各室壁基底段的STR值差异有统计学意义(P=0.002),两次STR值的相关系数为-0.10(P>0.05),两次STR值的平均差值为(3.98±9.36)%。两种方法测得的STR平均差值比较,差异有统计学意义(P<0.001)。(4)观察者之间可靠性:应用2D-STI法两者测得各室壁基底段的STR值差异无统计学意义(P=0.98),两者STR值的相关系数为0.60(P<0.001),两者STR值的平均差值为(-0.02±3.87)%。应用TDI法两者STR测值差异有统计学意义(P=0.00),两者STR值的相关系数为-0.11(P>0.05),两者STR值的平均差值为(4.86±10.26)%。两种方法测得STR的平均差值差异有统计学意义(P<0.001)。结论:应用2D-STI法定量评价左室局部心肌长轴的收缩功能更可靠。
OBJECTIVE: To investigate the reliability of 2D-STI in evaluating longitudinal segmental strain (STR) of left ventricular myocardium compared with tissue Doppler imaging (TDI). Methods: Thirty-five healthy volunteers were selected. Baseline segment, middle segment and apical segment of anterior wall, lateral wall, posterior wall, inferior wall, ventricular septum and anterior segment of left ventricle were measured by 2D-STI and TDI respectively. Longitudinal myocardial STR, observed its regularity. Then, randomly selected from 35 volunteers in 10 cases, using the two techniques were measured by the same observer were twice, and then by two observers measured the basal segment of left ventricular wall STR, the measured coefficient of variation , Correlation coefficient, average difference and so on. Results: (1) The results of 2D-STI showed that the basal segment of STR the middle segment of basal segment of STR and the apical segment. There were significant differences in STR values between different segments of the same wall measured by the two methods (P <0.05 or P <0.01). There was no significant difference in STR values between the same segment of different wall segments (P> 0.05) . (2) The coefficients of variation of basal segment, middle segment and apical segment STR of left ventricular wall measured by 2D-STI were lower than those of TDI (-0.25, -0.23, -0.26 vs-0.33, -0.35, -0.40). (3) The reliability of the same observer: There was no significant difference in STR values between the two basal segments detected by 2D-STI method (P = 0.86), the correlation coefficient between the two STRs was 0.73 ), The average difference between the two STR values was (-0.00 ± 3.19)%. There was significant difference in STR values between the two basal segments (P = 0.002) by TDI method. The correlation coefficient between the two STRs was -0.10 (P> 0.05). The mean difference between the two STR values (3.98 ± 9.36)%. The STR difference between the two methods was statistically significant (P <0.001). (4) Interobserver reliability: There was no significant difference in STR values of basal segment of each wall when using 2D-STI method (P = 0.98), and the correlation coefficient of STR value between the two was 0.60 (P < 0.001). The mean difference of STR values between the two groups was (-0.02 ± 3.87)%. There was significant difference between the two groups (P = 0.00). The correlation coefficient of STR value between the two groups was -0.11 (P> 0.05), and the difference between the two STR values was (4.86 ± 10.26)% . The difference between the two methods was statistically significant (P <0.001). Conclusion: 2D-STI quantitative assessment of left ventricular regional myocardial long axis systolic function more reliable.