| 摘要: |
| 目的 探讨应用三维应变超声成像（3D-STI）评价未发现节段性室壁运动异常（RWMA）的非ST段抬高型心肌梗死（NSTEMI）患者左室心肌力学改变的临床应用价值。方法 选择常规超声检查未发现RWMA的NSTEMI患者38例为病例组，另选健康成人30例为对照组，两组均行心脏超声、心肌酶谱及血生化检查。超声获得左室舒张末内径（LVED）、短轴缩短率（FS）、射血分数（LVEF）及每搏量（SV），应用3D-STI分析软件研究左室心肌应变，获得左室收缩期纵向应变（GLS）、径向应变（GRS）、圆周应变（GCS）及面积应变（GAS）。比较两组上述参数的差异，分析心肌应变参数与临床资料、血生化指标的相关性，绘制心肌应变参数诊断心肌梗死的受试者工作特征曲线（ROC），并计算其诊断效能。结果 两组间年龄、血压、血脂、血糖、血肌酐、血尿酸、血浆N末端B型钠尿肽前体（NT-proBNP）、肌酸激酶（CK-MB）水平比较差异均无统计学意义。与对照组比较，病例组GAS减小[（-31.27±1.87）% vs. （-42.02±1.26）%]，血心肌钙蛋白（Ihs-CTnI）增高[（2.11±1.78）% vs. （0.07±0.01）%]，差异均有统计学意义（t=17.02、6.25，均P=0.000）；而GLS、GRS、GCS、LVED、FS、LVEF及SV比较差异均无统计学意义。相关性分析表明：病例组患者GAS与LVEF、FS、hs-CTnI均呈正相关（r=0.45、0.25、0.61，均P＜0.05）。ROC曲线显示：GAS绝对值＜18.15%判断NSTEMI的敏感性92.1%%，特异性80.0%，曲线下面积0.91。结论 3D-STI能定量分析NSTEMI患者左室心肌力学特性，为临床评判NSTEMI提供无创、简便新方法。 |
| 关键词: 三维应变超声成像 非ST抬高型心肌梗死(NSTEMI) 左室 心肌力学 |
| DOI： |
| 投稿时间：2020-03-30修订日期：2020-09-14 |
| 基金项目:南京医科大学科研发展项目（立项号：2016NJMUZD098） |
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| Value of three-dimensional strain ultrasound imaging to evaluate left ventricular myocardial mechanics in NSTEMI patients |
| qingshunhua |
| (Pukou branch of Jiangsu People''s Hospital (Nanjing Pukou District Central Hospital)) |
| Abstract: |
| Objective To investigate the value ofthree-dimensional strain imaging（3D-STI） inevaluating left ventricular myocardial mechanics in patients withnon-ST-segment elevation myocardial infarction（NSTEMI）.
Methods Thirty-eight NSTEMI patients without regional wall motion abnormality（RWMA）from routine ultrasound examinationwere selected as the case group andthirty healthy people matched with age and sex were used as the control.Echocardiography，blood myocardial enzymes examination and blood biochemical testing were performed in all subjects.The left ventricular end-diastolic diameter（LVED），leftventricular fractional shortening （FS），left ventricular ejection fraction（EF） and stroke volume（SV）were measured.And then the global longitudinal peak systolic strain（GLS），global radial peak systolic strain（GRS），global circumferential peak systolic strain（GCS），and global area peak systolic strain（GAS） were obtained from 3D-STI.Results 1.Compared with the control group，GAS in the NSTEMI group was reduced [（-31.27 ± 1.87）% VS （-42.02 ± 1.26）%，t = 17.02，P = 0.000]，and the blood hs-CTnI increased [（2.11 ± 1.78） % VS （0.07 ± 0.01）%，t = 6.25，P = 0.000]，but there were no significant differences in GLS，GRS，GCS ，LVED，LVEF，FS andSV （P> 0.05）.2.There were no significant differences in age，blood pressure，blood lipids，blood glucose，blood creatinine，blood uric acid，blood CK-MB and NT-proBN between the two groups （P> 0.05）.3.Correlation analysis showed that there was a correlation between GAS and LVEF，FS，hs-CTnI （r = 0.45，0.25，0.61，P ＜0.05） while GAS didn’t correlated to LVED，SV，blood CK-MB，NT-proBN ，blood pressure and blood biochemical indicators significantly （P> 0.05）.The ROC curve shows that the sensitivity of evaluating NSTEMI is 92.1 %，the specificity is 80% according to the absolute value of GAS is less than 18.15%，and the area under the curve is 0.91.Conclusion 3D-STI can quantitatively analyze the mechanical characteristics of left ventricular myocardium in NSTEMI，and provide a non-invasive and simple new method for clinical evaluation of NSTEMI. |
| Key words: Three-dimensional strain imaging Non-ST-segment elevation myocardial infarction Left ventricle Myocardial mechanics |
