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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 425 -430. doi: 10.3877/cma.j.issn.1674-0785.2022.05.010

临床研究

三维斑点追踪技术联合血清同型半胱氨酸对冠心病患者左心功能的评估价值
蔡琦1, 雍永宏2,(), 何花1, 佘铜生1, 俞慧1   
  1. 1. 宣城市人民医院 超声医学科,242000 宣城
    2. 南京医科大学第一附属医院 心内科,21000 南京
  • 收稿日期:2021-12-13 出版日期:2022-05-15
  • 通信作者: 雍永宏
  • 基金资助:
    江苏省卫生计生委科研项目(H201610)

Evaluation of left ventricular function in patients with coronary heart disease by three-dimensional speckle tracking imaging combined with serum homocysteine

Qi Cai1, Yonghong Yong2,(), Hua He1, Tongsheng She1, Hui Yu1   

  1. 1. Department of Ultrasound Medicine, the People's Hospital of Xuancheng City, Xuancheng 242000, China
    2. Cardiology Department, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
  • Received:2021-12-13 Published:2022-05-15
  • Corresponding author: Yonghong Yong
引用本文:

蔡琦, 雍永宏, 何花, 佘铜生, 俞慧. 三维斑点追踪技术联合血清同型半胱氨酸对冠心病患者左心功能的评估价值[J/OL]. 中华临床医师杂志(电子版), 2022, 16(05): 425-430.

Qi Cai, Yonghong Yong, Hua He, Tongsheng She, Hui Yu. Evaluation of left ventricular function in patients with coronary heart disease by three-dimensional speckle tracking imaging combined with serum homocysteine[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(05): 425-430.

目的

分析三维斑点追踪成像技术(3D-STI)联合血清同型半胱氨酸HCY)对冠心病患者左心功能的评估价值。

方法

选取2018年5月至2021年6月宣城市人民医院收治的110例冠心病患者,均接受冠状动脉造影术,明确冠状动脉血流情况,根据左旋支、前降支及左冠状动脉单支血管直径狭窄程度分组,将直径狭窄≥50%的单支血管纳入研究组,将直径狭窄<50%的单支血管纳入对照组。比较两组心功能、应变参数、血清HCY,分析左心室应变参数与血清HCY相关性,绘制受试者工作特征(ROC)曲线,分析应变参数与HCY值联合诊断冠心病左心功能的价值。

结果

110例冠心病患者均经冠状动脉造影术明确,65例患者单支血管直径狭窄<50%,男性46例,女性19例,年龄(65.41±10.52)岁;45例单支血管直径狭窄≥50%,男性37例,女性8例,年龄(64.83±10.17)岁。研究组A峰高于对照组[(75.58±12.65) cm/s vs(61.02±10.71) cm/s],差异有统计学意义(t=6.506,P<0.001)。研究组左心室短轴缩短率(FS)、左心室射血分数(LVEF)、E峰、E/A值均低于对照组(t=4.616、2.709、2.103、3.896,P均<0.05)。研究组心室整体周向应变(GCS)、整体长轴应变(GLS)、整体径向应变(GRS)、整体面积应变(GAS)均低于对照组(t=8.617、10.535、5.971、6.766,均P<0.001),HCY高于对照组(t=4.915,P<0.001);经Pearson相关系数分析,HCY与GCS、GLS、GRS、GAS呈负相关(r=-0.725、-0.682、-0.762、-0.758,均P<0.001);绘制ROC曲线发现,GCS、GLS、GRS、GAS、HCY及应变参数联合HCY诊断冠心病的曲线下面积(AUC)(95%CI)分别为0.853(0.751~0.954)、0.898(0.802~0.993)、0.731 (0.595~0.868)、0.847(0.735~0.960)、0.863 (0.768~0.957)、0.990(0.973~1.000)。

结论

3D-STI应变参数与HCY密切相关,二者联合可有效评估冠心病左心功能。

Objective

To evaluate the value of three-dimensional spot tracking imaging technology (3D-STI) combined with serum homocysteine (HCY) in the evaluation of left heart function in patients with coronary heart disease.

Methods

A total of 110 patients with coronary heart disease admitted to the People's Hospital of Xuancheng City from May 2018 to June 2021 were selected. All patients underwent coronary angiography to clarify the coronary blood flow. According to the degree of stenosis of the left circumflex branch, anterior descending branch, and single vessel of the left coronary artery, single vessels with stenosis ≥50% in diameter were included in the study group, and those with stenosis <50% in diameter was included in a control group. The relationship between left ventricular strain parameters and serum HCY was analyzed, and the receiver operating characteristic (ROC) curve was plotted to assess the value of HCY combined with strain parameters in evaluating left ventricular function in patients with coronary heart disease.

Results

All the 110 patients had coronary heart disease confirmed by coronary angiography. Sixty-five patients had single vessel with a diameter less than 50%, including 46 males and 19 females, with an average age of (65.41±10.52) years; 45 had single vessel stenosis ≥50%, including 37 males and 8 females, with an average age of (64.83±10.17) years. Peak A in the study group was higher than that in the control group [(75.58±12.65) cm/s vs (61.02±10.71) cm/s], and the difference was statistically significant (t=6.506, P<0.001). The left ventricular short axis shortening rate (FS), left ventricular ejection fraction (LVEF), E peak, and E/A value in the study group were all lower than those in the control group (t=4.616,2.709,2.103, and 3.896, respectively; P<0.05). The overall peripheral strain (GCS), overall long axial strain (GLS), overall radial strain (GRS), and overall area strain (GAS) in the study group were all lower than those in the control group (t=8.617, 10.535, 5.971, and 6.766, respectively; P<0.001), and HCY was higher than that in the control group (t=4.915, P<0.001). Pearson correlation analysis showed that HCY was negatively correlated with GCS, GLS, GRS, and GAS (r=-0.725, -0.682, -0.762, and -0.758, respectively; P<0.001). The area under the curve (95% confidence interval) of GCS, GLS, GRS, GAS, HCY, and strain parameters combined with HCY in diagnosing CHD was 0.853 (0.751-0.954), 0.898 (0.802-0.993),0.731 (0.595-0.868), 0.847 (0.735-0.960), 0.863 (0.768-0.957), and 0.990 (0.973-1.000), respectively.

Conclusion

3D-STI strain parameters are closely correlated with HCY, and their combination can effectively evaluate left heart function in patients with coronary heart disease.

表1 两组不同直径狭窄冠心病患者一般资料比较
xˉ
±s
表2 两组冠心病患者心功能比较(
xˉ
±s
表3 两组不同直径狭窄冠心病患者左心室应变参数、HCY水平比较(
xˉ
±s
表4 不同直径狭窄冠心病患者左室应变参数和血清HCY诊断冠心病血管狭窄程度的ROC曲线分析结果
图1 不同直径狭窄冠心病患者应变参数和血清HCY诊断冠心病血管狭窄程度的ROC曲线 注:HCY为同型半胱氨酸;ROC曲线为受试者工作特征曲线;GCS为整体周向应变;GLS为整体长轴应变;GRS为左心室整体径向应变;GAS为左心室整体面积应变
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