应用 4D 斑点追踪超声心动图分析心肌应变预测稳定性心绞痛患者冠状动脉疾病严重程度。
Myocardial strain analysis by 4D-speckle tracking echocardiography for prediction of coronary artery disease severity in patients with stable angina pectoris.
机构信息
Consultant and Interventional Cardiologist in Department of Cardiology, Alliance Multispeciality Hospital, Ichalkaranji, Kolhapur, 416115, Maharashtra, India.
Fellow of Interventional Cardiology (Toronto, Canada), Fellow of Electrophysiology (Toronto Canada), Head of Department in Department of Cardiology, Poona Hospital and Research Centre, Pune, 411030, Maharashtra, India.
出版信息
Indian Heart J. 2023 May-Jun;75(3):177-184. doi: 10.1016/j.ihj.2023.03.002. Epub 2023 Mar 7.
OBJECTIVE
We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score.
METHODS
The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0-19), n = 117] and critical stenosis group [Gensini score ≥20, n = 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated.
RESULTS
Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (ρ) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (ρ = -0.433, p < 0.001). A 4D GLS value of ≥ -17 had 84.9% sensitivity and 97.4% specificity, GAS ≥ -31 (90.9% sensitivity, 78.6% specificity), GCS ≥ -17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score ≥20.
CONCLUSION
The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.
目的
应用四维斑点追踪超声心动图（4D-STE）评估稳定型心绞痛（SAP）患者的心肌应变，根据 Gensini 评分确定冠状动脉疾病（CAD）的严重程度。
方法
本研究纳入 150 例 SAP 患者。对有 SAP 病史、左心室射血分数正常且无局部室壁运动异常（RWMA）的患者行选择性冠状动脉造影。根据 Gensini 评分，分为非临界狭窄组[Gensini 评分（0-19），n=117]和临界狭窄组[Gensini 评分≥20，n=33]。分析 Gensini 评分与 4D-STE 应变参数的相关性。
结果
在 150 例患者中，临界狭窄组的所有 4D-STE 应变参数值均显著低于非临界狭窄组（p<0.001），除了整体径向应变（GRS）参数。Spearman 相关系数（ρ）显示 Gensini 评分与 4D 整体纵向应变（GLS）、整体圆周应变（GCS）、整体面积应变（GAS）呈显著正相关（ρ分别为 0.626、0.548 和 0.631，p<0.001），而 Gensini 评分与 GRS 呈显著负相关（ρ=-0.433，p<0.001）。4D GLS 值≥-17 的敏感性为 84.9%，特异性为 97.4%；GAS≥-31 的敏感性为 90.9%，特异性为 78.6%；GCS≥-17 的敏感性为 69.7%，特异性为 92.3%；GRS<47 的敏感性为 72.7%，特异性为 76.1%，可检测 Gensini 评分≥20 描述的临界 CAD。
结论
在传统超声心动图无 RWMA 的 SAP 患者中，4D-STE 可评估严重 CAD 狭窄，具有较好的敏感性和特异性。
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