应用彩色室壁运动技术检测冠心病患者左心室收缩和舒张功能异常

Detection of left ventricular systolic and diastolic abnormalities in patients with coronary artery disease by color kinesis.

作者信息

Vitarelli A, Sciomer S, Schina M, Luzzi M F, Dagianti A

机构信息

Cardiac Department, La Sapienza University, Rome, Italy.

出版信息

Clin Cardiol. 1997 Nov;20(11):927-33. doi: 10.1002/clc.4960201106.

DOI:10.1002/clc.4960201106

PMID:9383586

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6655956/

Abstract

BACKGROUND

Color kinesis (CK) is a recently developed echocardiographic technique based on acoustic quantification that automatically tracks and displays endocardial motion in real time and has been used in initial studies to improve the evaluation of global and regional wall motion.

HYPOTHESIS

For further validation of the use of CK for analysis of segmental ventricular dysfunction, we assessed its sensitivity and specificity for detection of regional systolic and diastolic wall motion abnormalities in patients with coronary artery disease (CAD).

METHODS

Two-dimensional (2-D) echocardiography and CK were used to study 15 normal subjects and 63 patients with technically good quality echocardiographic tracings, who underwent coronary arteriography within 1 month of echocardiography. Significant (> 70% luminal diameter stenosis) CAD was present in 50 patients (79%).

RESULTS

Color kinesis tracked endocardial motion accurately in 93% of left ventricular segments. Wall motion score, systolic segmental endocardial motion (SEM), and the time of systolic SEM (tSEM) and diastolic (tDEM) segmental endocardial motion were calculated. Intra- and interobserver variability were within narrow limits. SEM and tSEM were significantly lower and tDEM was significantly higher in the patient population than in the control group (p < 0.001). Comparison between CK and 2-D echocardiography showed a correlation coefficient of 0.81 between the two techniques. The score was identically graded in 74% of segments, with concordance of 82% in diagnosing segments as abnormal. Interobserver concordance was 86% for CK (r = 0.85) and 81% for 2-D echocardiography (r = 0.80). The sensitivity and specificity of systolic and diastolic CK parameters for the detection of CAD were 88 and 92% and 77 and 85%, respectively. The positive predictive values were 93 and 96%, respectively, the negative predictive values were 63 and 73%, respectively, and the overall accuracy was 86 and 91%, respectively.

CONCLUSIONS

Our data suggest that CK is a feasible and sensitive technique for identifying regional systolic as well as diastolic wall motion abnormalities in patients with CAD.

摘要

背景

彩色室壁运动分析（CK）是一种最近基于声学定量技术发展起来的超声心动图技术，可实时自动追踪并显示心内膜运动，已用于初步研究以改善对整体和局部室壁运动的评估。

假设

为进一步验证CK用于分析节段性心室功能障碍的有效性，我们评估了其在检测冠心病（CAD）患者局部收缩期和舒张期室壁运动异常方面的敏感性和特异性。

方法

使用二维（2-D）超声心动图和CK对15名正常受试者和63例超声心动图记录质量良好的患者进行研究，这些患者在超声心动图检查后1个月内接受了冠状动脉造影。50例患者（79%）存在显著（>70%管腔直径狭窄）的CAD。

结果

CK在93%的左心室节段中准确追踪了心内膜运动。计算了室壁运动评分、收缩期节段性心内膜运动（SEM）、收缩期SEM时间（tSEM）和舒张期（tDEM）节段性心内膜运动。观察者内和观察者间的变异性在狭窄范围内。患者组的SEM和tSEM显著低于对照组，tDEM显著高于对照组（p<0.001）。CK与2-D超声心动图之间的比较显示两种技术的相关系数为0.81。74%的节段评分相同，在诊断节段异常方面的一致性为82%。CK的观察者间一致性为86%（r=0.85），2-D超声心动图为81%（r=0.80）。收缩期和舒张期CK参数检测CAD的敏感性和特异性分别为88%和92%以及77%和85%。阳性预测值分别为93%和96%，阴性预测值分别为63%和73%，总体准确性分别为86%和91%。