三维斑点追踪技术评价老年冠心病患者左室心肌力学特性

doi:10.3969/j.issn.1003-9198.2026.06.015

摘要/Abstract

摘要： 目的运用三维斑点追踪成像(3D-STI)技术评价静息状态下无节段性室壁运动异常(RWMA)的老年CHD患者左室心肌力学特性,并基于Gensini评分(GS)探讨其对冠脉病变严重程度的评估价值。方法本研究共纳入56例接受冠状动脉造影(CAG)、LVEF正常且无RWMA的老年CHD患者。所有患者均接受常规超声心动图及三维斑点追踪超声心动图检查。根据GS水平将患者分为2组:无显著狭窄组(GS≤38分)25例,显著狭窄组(GS＞38分)31例。比较2组的一般临床资料、常规超声心动图参数及3D-STI应变参数;分析3D-STI参数与GS的相关性;采用ROC曲线评估3D-STI参数对严重CHD(GS＞38分)的诊断效能。结果显著狭窄组整体面积应变(GAS)和整体纵向应变(GLS)均明显低于无显著狭窄组(P＜0.05);2组间整体圆周应变(GCS)和整体径向应变(GRS)比较,差异没有统计学意义(P＞0.05)。相关性分析显示,GS与GAS及GLS均呈显著正相关(r=0.715、0.671,P<0.01)。ROC曲线分析结果显示,GAS以-28.5%为截断值时,诊断严重CHD的敏感度为93.5%、特异度为72.0%(AUC=0.912);GLS以-16.5%为截断值时,诊断严重CHD的敏感度为61.3%、特异度为80.0%(AUC=0.791)。结论无RWMA老年CHD患者的3D-STI左室心肌应变参数改变有一定特征性,且与冠状动脉病变严重程度密切相关。其中GAS对该类患者具有良好评估效能,可作为其冠脉病变严重程度的有效无创检测指标。

关键词: 三维斑点追踪成像, 冠状动脉疾病, Gensini 评分, 老年人

Abstract: Objective To evaluate the left ventricular myocardial mechanics in elderly patients with coronary heart disease (CHD) without no regional wall motion abnormalities (RWMA)at rest using three-dimensional speckle tracking imaging (3D-STI), and to determine the technique's efficacy in evaluating the serious degree of CHD, as quantified by the Gensini score (GS). Methods A total of 56 elderly patients with normal left ventricular ejection fraction and no RWMA who underwent coronary angiography (CAG) were enrolled in this study. Each participant underwent both standard echocardiographic examination and three-dimensional speckle tracking echocardiographic assessment. The patients were divided into two groups according to the Gensini score(GS): the non-significant stenosis group (GS≤38, n=25) and the significant stenosis group(GS>38, n=31) .General clinical data, standard echocardiographic measurements, and strain parameters derived from 3D-STI were compared between the two groups. The correlations between 3D-STI parameters and GS were analyzed. The diagnostic efficacy of 3D-STI parameters for severe CHD (GS>38) was evaluated using the receiver operating characteristic (ROC) curve. Results There were statistically significant differences in global area strain (GAS) and global longitudinal strain (GLS) between the two groups (P<0.05). However, global circumferential strain (GCS) and global radial strain (GRS) showed no significant differences between the two groups (P>0.05). A significant positive correlation was identified between the GS and both GAS (r=0.715, P<0.001) and GLS (r=0.671, P< 0.01).ROC curve analysis revealed that GAS had high diagnostic value for identifying severe CHD, with a cut-off value of -28.5%, a sensitivity of 93.5%, and a specificity of 72.0% (AUC=0.912). For GLS, a cut-off value of -16.5% provided a sensitivity of 61.3% and a specificity of 80.0% for detecting severe CHD, corresponding to an AUC of 0.791. Conclusions In the elderly patients with CHD without RWMA, left ventricular myocardial strain parameters measured by 3D-STI show certain characteristic changes and are closely associated with the severity of coronary artery lesions. Among these parameters, GAS demonstrates good evaluative efficacy and may serve as an effective non-invasive predictor for the severity of coronary artery lesions.

Key words: three-dimensional speckle tracking imaging, coronary artery disease, Gensini score, aged

中图分类号:

R 541.4

沈波, 曹美, 惠文卿, 张平洋. 三维斑点追踪技术评价老年冠心病患者左室心肌力学特性[J]. 实用老年医学, 2026, 40(6): 619-623.

SHEN Bo, CAO Mei, HUI Wenqing, ZHANG Pingyang. Evaluation of left ventricular myocardial mechanical properties in aged patients with coronary heart disease using three-dimensional speckle tracking imaging[J]. Practical Geriatrics, 2026, 40(6): 619-623.

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