摘要
目的探讨超声斑点追踪技术(STE)与组织多普勒技术(TDI)分别联合多巴酚丁胺负荷试验检测存活心肌的临床价值。方法左心室收缩功能下降(左心室射血分数<50%)冠心病患者37例,在血运重建之前进行联合多巴酚丁胺负荷超声心动图(DSE)的STE与TDI检查,分析计算室壁运动异常节段(RWMA)的静息及DSE后纵向应变率(LSR)和收缩期峰值速度(PSV)。血运重建后1、3、6个月分别复查超声心动图,室壁运动改善为判定存活心肌的金标准,分析STE与TDI检测存活心肌的价值。结果检查RWMA214个,金标准检测119个节段为存活心肌,95个节段为非存活心肌。存活心肌与非存活心肌的LSR和PSV在静息状态下比较差异有统计学意义(P<0.01),存活心肌组的LSR和PSV在DSE前后比较差异有统计学意义(P<0.01),而非存活心肌组的LSR和PSV在DSE前后差异无统计学意义(P>0.05)。受试者工作特征(ROC)曲线判定以△LSR(%)≥7.14%为截断点,检测存活心肌的敏感度88.2%,特异度80.0%;以△PSV(%)≥8.04%为截断点,检测存活心肌的敏感度74.8%,特异度83.2%。联合运用LSR和PSV两项指标,检测存活心肌的敏感度和特异度分别提高至89.8%、88.7%。结论 STE与TDI联合DSE检测存活心肌的敏感度和特异度有明显提高,适宜在临床推广使用。
Objective To explore the significance and value of speckle tracking strain echocardiography（STE）and tissue Doppler imaging（TDI）under dobutamine stress echocardiography（DSE）for evaluation of viable myocardium in patients with coronary artery disease（CAD）.Methods A total of 37 hospitalized patients with left ventricular systolic dysfunction（left ventricular ejection fraction,LVEF〈50%）were included in this study according to routine echocardiography.All of them underwent STE and TDI associated with DSE by Philips iE33 prior to revascularization.Every regional wall motion abnormalities（RWMA）image was acquired and evaluated by wall-motion analysis.The images of STE and TDI were analyzed quantitatively for the long axis peak-systolic longitudinal strain rate（LSR）and peak systolic velocity（PSV）.Revascularization was performed within one week after STE and TDI associated with DSE in all patients.The movement of each segment was observed by routine echocardiography after 1,3,6months of revascularization and its improvement was treated as a gold standard of judging viable myocardium.The clinical value of STE and TDI in detecting viable myocardium was evaluated.Results Of the 214 segments with abnormal wall-motion by routine echocardiography,119 segments showed viable myocardium judged by gold standard.There were significant differences in LSR and PSV at rest between viable myocardium and non-viable myocardium（P0.01）.LSR and PSV were significantly different after DSE in viable myocardium（P〈0.01）,while in non-viable myocardium there were no significant changes after DSE（P 〉0.05）.From the ROC curve,the cutoff was△LSR（%）≥7.14%,the sensitivity and specificity were 88.2% and 80.0% in detecting viable myocardium,respectively;the cutoff was △PSV（%）≥8.04%,the sensitivity and specificity were 74.8% and 83.2%,respectively.Combining△LSR（%）with △PSV（%）,the sensitivity and specificity for assessment of viable myocardium rose to 89.8% and88.7%,respectively.Conclusion The sensitivity and specificity for assessment of viable myocardium were obviously increased by STE and TDI under DSE and it is suitable for clinical work widely.
出处
《临床荟萃》
CAS
2015年第7期765-768,共4页
Clinical Focus
