心肌分层应变对冠状动脉复杂多支病变的预测价值

doi:10.3969/j.issn.2095-9400.2019.02.010

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Abstract Objective: To apply layer-specific strain (LSS) to assess the left ventricular of patients with suspected coronary artery disease (CAD) to identify whether myocardial strain can predict the presence of complex multi-vessel disease of the coronary artery. Methods: A total of 116 patients with suspicious CAD in Taizhou Hospital from January 2014 to December 2015 were included. All patients were underwent coronary angiography and were divided into 3 groups: control group (no significant coronary stenosis was considered as a <50% reduction of vessel diameter in every coronary artery and its main branch, n=29), 1-2 vessel disease group [1-vessel disease (1VD) or 2-vessel disease (2VD) was defined as a ≥50% reduction of lumen diameter in 1 or 2 major coronary artery n=43] and complex CAD group (left main branch and/or 3VD of each coronary lesion with ≥50% stenosis, n=44). Endocardial, mid-myocardial, epicardial global longitudinal (GLS) and circumferential stain (GCS) of left ventricules were measured by LSS. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of GLS and GCS for complex multivessel disease. Results: Compared with controls, endocardial, mid-myocardial, epicardia GLS and GCS in complex CAD were all statistically reduced (P<0.01). Compared with 1-2VD, endocardial, mid-myocardial, epicardial GLS and endocardial, mid-myocardial GCS in complex CAD were all significantly reduced (P<0.05). By ROC analysis, GLS showed better diagnostic accuracy for identifying complex CAD: the cutoff value of endocardial GLS was -21.00%; the sensitivity and specificity were 75.0% and 75.0% respectively; the cutoff value of mid-myocardial GLS was -18.65%; the sensitivity and specificity were 72.2% and 70.5% respectively; the cutoff value of epicardial GLS was -15.95%; the sensitivity and specificity were 73.6% and 70.5% respectively. However,endocardial GLS demonstrated the highest value with 0.50 in Youden index. Conclusion: The measurement of GLS, especially endocardial GLS, might be a non-invasive method to identify complex CAD.

Key words： layer-specific stain coronary artery disease ventricular function, left echocardiography

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	YANG Xing’an
	ZHU Jia
	ZHENG Jiehuai.

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https://xb.wmu.edu.cn/EN/10.3969/j.issn.2095-9400.2019.02.010 OR https://xb.wmu.edu.cn/EN/Y2019/V49/I2/128

[1] SUN J P, XU T, YANG Y, et al. Layer-specific quantification of myocardial deformation may disclose the subclinical systolic dysfunction and the mechanism of preserved ejection fraction in patients with hypertension[J]. Int J Cardiol, 2016, 219:172-176.
[2] EJLERSEN J A, POULSEN S H, MORTENSEN J, et al. Diagnostic value of layer-specific global longitudinal strain during adenosine stress in patients suspected of coronary artery disease[J]. Int J Cardiovasc Imaging, 2017, 33(4): 473-480.
[3] 陈小果, 舒先红. 超声心动图心肌分层应变的临床应用进展[J]. 中华超声影像学杂志, 2016, 25(7): 638-640.
[4] 杨性安, 余力, 勾常龙, 等. 三维应变成像对高危冠状动脉粥样硬化性心脏病患者的早期诊断价值[J]. 中华医学超声杂志(电子版), 2016, 13(7): 504-509.
[5] 王建安. 血流储备分数与冠状动脉功能评价[M]. 1版. 北京: 人民卫生出版社, 2012: 54-66.
[6] 龚晓萍, 李艳红, 穆玉明, 等. 三维斑点追踪牛眼图对冠状动脉多支病变的诊断价值[J]. 中华超声影像学杂志, 2015, 24(5): 387-392.
[7] CHOI J O, CHO S W, SONG Y B, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality[J]. Eur J Echocardiogr, 2009, 10(5): 695-701.
[8] 刘佳霓, 刘佳升, 白文娟, 等. 三维斑点追踪成像定量评价不同狭窄程度冠心病患者左心室收缩功能的应用价值[J].中华超声影像学杂志, 2015, 24(1): 1-5.
[9] 刘昕, 薛娜, 高磊, 等.无节段性室壁运动异常冠心病患者左心室三维应变与冠状动脉造影的对比研究[J]. 中华超声影像学杂志, 2015, 24(12): 1028-1032.
[10] 宋宏宁, 秦真英, 周青, 等. 应用三维斑点追踪技术构建多参数诊断模型提高冠状动脉狭窄早期诊断效率[J]. 中华超声影像学杂志, 2015, 24(2): 100-104.
[11] 郭艳杰, 孙品, 张芬, 等. 二维斑点追踪成像技术评价不同程度冠状动脉狭窄对左心室功能的研究[J]. 中国超声医学杂志, 2016, 32(6): 507-510.
[12] 赵志玉, 陈金玲, 周青, 等. 心肌纵向分层应变参数评价冠心病患者左心室局部及整体收缩功能[J]. 中华超声影像学杂志, 2016, 25(1): 1-6.
[13] HAMADA S, SCHROEDER J, HOFFMANN R, et al. Prediction of outcomes in patients with chronic ischemic cardiomyopathy by layer-specific strain echocardiography: a proof of concept[J]. J Am Soc Echocardiogr, 2016, 29(5): 412-420.
[14] PARK J H, WOO J S, JU S, et al. Layer-specific analysis of dobutamine stress echocardiography for the evaluation of coronary artery disease[J]. Medicine (Baltimore), 2016, 95(32): e4549.
[15] 林洁, 严志汉. 心肌分层应变评估重度主动脉瓣狭窄患者左室心肌收缩功能变化[J]. 温州医科大学学报, 2018, 48(4): 289-293.
[16] SARVARI S I, HAUGAA K H, ZAHID W, et al. Layer-specific quantification of myocardial deformation by strain echocardiography may reveal significant CAD in patients with non-ST-segment elevation acute coronary syndrome[J]. JACC Cardiovasc Imaging, 2013, 6(5): 535-544.
[17] 储彦芬, 唐海沁, 汪太平, 等. 二维斑点追踪技术评价冠心病患者左室整体收缩功能及其与冠状动脉病变程度的关系[J]. 安徽医科大学学报, 2015, 50(1): 83-86.
[18] ZHANG L, WU W C, MA H, et al. Usefulness of layer-specific strain for identifying complex CAD and predicting the severity of coronary lesions in patients with non-ST-segment elevation acute coronary syndrome: Compared with Syntax score[J]. Int J Cardiol, 2016, 223: 1045-1052.