应用二维斑点追踪超声心动图评估冠状动脉慢血流现象患者左、右心室舒张和收缩功能
Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon.
作者信息
Wang Yonghuai, Ma Chunyan, Zhang Yan, Guan Zhengyu, Liu Shuang, Li Yuling, Yang Jun
机构信息
Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
出版信息
PLoS One. 2015 Feb 23;10(2):e0117979. doi: 10.1371/journal.pone.0117979. eCollection 2015.
OBJECTIVE
Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterised by a low rate of flow of contrast agent in the normal or near-normal epicardial coronary arteries. Many of the patients with CSFP may experience recurrent acute coronary syndromes. However, current clinical practice tends to underestimate the impact of CSFP due to the yet unknown effect on the cardiac function. This study was performed to evaluate left ventricular (LV) and right ventricular (RV) diastolic and systolic functions, using two-dimensional (2D) longitudinal strain and strain rate, in patients with CSFP, and to determine the relationships between the thrombolysis in myocardial infarction (TIMI) frame count (TFC) and LV and RV diastolic and systolic functions.
METHODS
Sixty-three patients with CSFP and 45 age- and sex-matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TFC. LV and RV diastolic and systolic functions were assessed by 2D speckle-tracking echocardiography.
RESULTS
LV peak early diastolic longitudinal strain rate (LSRe) was lower in patients with CSFP than in controls (P = 0.01). LV peak systolic longitudinal strain (LS) and LV peak systolic longitudinal strain rate (LSRs) were lower in patients with CSFP than in controls (P = 0.004 and P = 0.03, respectively). There was no difference in LV ejection fraction. RV peak early diastolic longitudinal strain rate (RSRe) was lower in patients with CSFP than in controls (P = 0.03). There were no differences in RV peak systolic longitudinal strain (RS), RV peak systolic longitudinal strain rate (RSRs), or RV fractional area change among the groups. The mean TFC correlated negatively with LSRe and RSRe in patients with CSFP (r = -0.26, P = 0.04 and r = -0.32, P = 0.01, respectively).
CONCLUSIONS
LV diastolic and systolic functions were impaired in patients with CSFP. CSFP also affected RV diastolic function, but not RV systolic function.
目的
冠状动脉慢血流现象（CSFP）是一种血管造影诊断，其特征为正常或接近正常的心外膜冠状动脉中造影剂的血流速度较低。许多CSFP患者可能会经历复发性急性冠状动脉综合征。然而，由于对心脏功能的影响尚不清楚，目前的临床实践往往低估了CSFP的影响。本研究旨在使用二维（2D）纵向应变和应变率评估CSFP患者的左心室（LV）和右心室（RV）舒张和收缩功能，并确定心肌梗死溶栓（TIMI）帧数（TFC）与LV和RV舒张和收缩功能之间的关系。
方法
本研究纳入了63例CSFP患者和45例年龄和性别匹配的无CSFP对照者。通过TFC诊断CSFP。通过二维斑点追踪超声心动图评估LV和RV舒张和收缩功能。
结果
CSFP患者的LV舒张早期纵向应变率峰值（LSRe）低于对照组（P = 0.01）。CSFP患者的LV收缩期纵向应变峰值（LS）和LV收缩期纵向应变率峰值（LSRs）低于对照组（分别为P = 0.004和P = 0.03）。LV射血分数无差异。CSFP患者的RV舒张早期纵向应变率峰值（RSRe）低于对照组（P = 0.03）。各组之间的RV收缩期纵向应变峰值（RS）、RV收缩期纵向应变率峰值（RSRs）或RV面积变化分数无差异。CSFP患者的平均TFC与LSRe和RSRe呈负相关（分别为r = -0.26，P = 0.04和r = -0.32，P = 0.01）。
结论
CSFP患者的LV舒张和收缩功能受损。CSFP也影响RV舒张功能，但不影响RV收缩功能。
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