【作者】 曹阿丹；

【导师】 牛玉军；

【作者基本信息】 辽宁医学院 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的以TTE为对照,探讨MSCTCA和TTE定量评价心功能的相关性,并进一步探讨MSCTCA无创性评价冠状动脉狭窄程度与左心结构和整体收缩功能的相关性。方法收集2009年12月至2010年11月间行MSCTCA检查的200例拟诊为冠心病患者(其中30例同时行TTE检查),男130例,女70例,年龄33～88岁,平均年龄58±23岁,分别测量每一患者心腔结构和功能指标。MSCTCA和TTE检查时间间隔不超过12个小时。利用MSCTCA的原始数据进行多时相重建间隔10%的10组数据。在心脏左室短轴、长轴和四腔心切面观察左心室动态变化,参照心电图,确定体积最小为收缩末期,最大为舒张末期。通常收缩末期在R-R间期的20%～40%,舒张末期在R-R间期的65%～85%。在circulation软件中进行左心功能分析,勾画出舒缩末期左心室内膜及外膜轮廓,左室流出道和乳头肌包含于血池内。利用Simpson法计算出左心功能指标:舒张末期体积(EDV)、收缩末期体积(ESV)、每搏输出量(SV)、射血分数(EF)、左室短轴缩短率(FS)和心肌质量(MM);同时在circulation或Inspace软件内进行血管分析。超声心动图检查使用仪器为HP Sonos-5500型彩色多普勒超声心动图仪,应用M型测定左心室收缩功能,由两名超声科副主任职称以上医师独立完成。30例根据检查方法不同分成MSCTCA组和TTE组;根据AHA冠状动脉17段分段法,对MSCTCA显示的各支狭窄节段进行Gensini积分评估,根据狭窄程度积分结果可分为4组:正常组(GS<5分)、轻度病变组(5≤GS<25分)、中度病变组(25≤GS<60分)、重度病变组(GS≥60分)。统计学采用SPSS 17.0软件进行统计处理。计量资料以均数±标准差( x±s)表示,计数资料采用例数或率(%)表示。MSCTCA和TTE评价心功能指标采用配对t检验及Pearson线性相关分析;不同狭窄组间比较采用单因素方差分析;Gensini积分与各心功能指标关系采用Spearman相关性检验。均以P<0.05为差异有统计学意义。结果所有检查患者均顺利进行,共有200例,其中30例行MSCTCA和TTE两项检查。两种检查方法测得的EDV、ESV、SV、EF和FS等心功能指标(见表1)进行配对t检验后,结果各均值比较差异无统计学意义(P均>0.05)。EDV、ESV、SV均值:MSCT>TTE; EF、FS均值:MSCT<TTE。两种检查方法进行Pearson相关性分析,在EDV、ESV、SV、EF和FS的相关系数r分别为0.910、0.921、0.904、0.905、0.891(P均<0.05)。冠状动脉狭窄与心功能指标结果:由低到高Gensini积分四分位分组后,患者的LVDD、LADD、EDV、ESV、MM、EF、FS、SV在不同评分间差异有统计学意义(P<0.05)(见表3),CO各组间差异无统计学意义(P>0.05)。GS与各变量间Spearman相关性分析:GS与SV、EF、FS呈线性负相关,与LVDD、LADD、EDV、ESV、MM呈线性正相关(P均<0.05),与CO无显著相关性(P>0.05),MM与EF、FS呈线性负相关(P均<0.05)。结论MSCT在左心功能定量评价方面结果准确、可靠,与超声心动图(TTE)相关性高。冠状动脉狭窄Gensini积分与左室收缩功能呈线性负相关,与心肌质量呈线性正相关,即冠状动脉愈狭窄,心功能愈差。冠状动脉狭窄可能是造成左室收缩功能减低和心肌重塑的一个重要原因。更多还原

【Abstract】 ObjectiveTo discuss correlation between Multi-slice spiral CT coronary artery angiography (MSCTCA) and Transthoracic echocardiography (TTE)in the quantitative evaluation of left ventricular function,and further to discuss relationship between the severity of coronary artery stenosis,left ventricle anatomy and global systolic function noninvasively evaluated by Multi-slice spiral CT.MethodsFrom December 2009 to November 2010,thirty patients among 200 suspicious coronary heart disease evaluated by MSCTCA simultaneously were examined by TTE ,which included 130 male cases and 70 females cases, aged range from 33 to 88 years old,mean age 58±23 years. Cardiac anatomy ang functional parameters of each patient were measured. The both examination time intervals by MSCTCA and TTE was less than 12 hours.Ten series of images were reconstructed at every 10% R-R interval by using the MSCTCA raw data set. From the reconstructed cardiac planes CT images (left ventricle short axis, long axis, and four-chamber view),the minimum systolic volumes and maximum diastolic volumes were determined by observing dynamic changes of left ventricular volume according to ECG. Usually,systolic phase in the 20% to 40% R-R interval, the diastolic phase in the 60% to 80% R-R interval. The contours of endocardium and epicardium diastolic and systolic end phases were outlined in the circulation cardiac functional software,and left ventricular outflow tract and papillary muscles were included in the blood pool.The left ventricular function parameters,such as end-diastolic volume (EDV), end systolic volume (ESV), and stroke volume (SV), ejection fraction (EF), left ventricular fraction shortening (FS) and cardiac mass (MM),were calculated by using Simpson’s method. And each coronary artery stenosis was evaluated by the circulation or Inspace vessel analysis software.Echocardiography was performed independently using the instruments HP Sonos-5500 Color Doppler ultrasound diagnostic apparatus by two associate chief physician. The left ventricular function by M-mode Color Doppler was determined.Thirty patients underwent by the both checking modality were divided into two group,respectively MSCTCA and TTE. According to 17-segment modified AHA classification, the stenosis of each branch segment were assessed by Gensini’s score. Two hundred patients underwent by MSCTCA modality were divided into four groups,respectively normal group (GS<5 scores), mild disease group (5 scores≤GS <25 scores), moderate disease group (25 scores≤GS <60 scores), severe disease group (GS≥60 scores).The data was analyzed Statistically by using SPSS17.0 software package. The quantitative data was expressed as mean±standard deviation( x±s),and the qualitative data was expressed as cases or rate(%).The both cardiac functional parameters performed by MSCTCA and TTE was analyzed by paired-t test,the correlation of the both was analyzed by using Pearson linear correlation test. Gensini’s score level as a categorical variable ordering was grouped by quartile values, the group’s differences were analyzed using single factor analysis of variance(ANOVA).The correlation between every cardiac functional parameters and Gensini’s scores was analyzed by using Spearman linear correlation test. P<0.05 was considered statistically significance.ResultsA total of 200 patients were successfully carried out by MSCTCA,of which 30 cases were undergone by MSCTCA and TTE. The results of cardiac function such as EDV, ESV, SV, EF and FS ,measured by the both methods,were tested by paired-t test, the differences were not statistically significant (P> 0.05). EDV, LVESV, SV mean: MSCT>TTE; EF and FS mean: MSCT<TTE. The both methods were perfectly correlated with Pearson correlation analysis, respectively,the correlation coefficient r of EDV,ESV,SV,EF and FS were 0.910,0.921,0.904,0.905,0.891 (P<0.05).The results of coronary artery stenosis and cardiac function analysis:Gensini’s score level was grouped as a categorical variable ordering by quartile values, there were significant differences in ejection fraction(EF), fraction shortening (FS), end-diastolic volume(EDV), end-systolic volume (ESV) ,left ventricular end diastolic dimension (LVDD), left atrium end-diastolic dimension(LADD) , stroke volume (SV),and myocardial mass (MM) (P <0.001) ,however, differences in cardiac output(CO) were no significant(P>0.05). Compared Gensini’s score with Spearman, Gensinis’score was positively correlated with EDV、ESV、LVDD、LADD and MM, conversely,Gensinis’score was negatively correlated with SV,EF and FS(P<0.05),and was no significant correlation with and CO(P>0.05). ConclusionsCompared with TTE, the quantitative evaluation of left ventricular functional parameters by MSCT is accurate and reliable, and the correlation of cardiac function measured by the both examination was quite excellent. Gensini’s score(GS) of coronary artery stenosis was negatively correlated with left ventricular systolic function(EF,FS), but was positively correlated with myocardial mass(MM).that is, the more stenosis coronary artery, the worse cardiac function. Coronary artery stenosis is an important reason that caused left ventricular global systolic dysfunction and cardiac remodeling.更多还原