不同超声评估方法在左前降支狭窄中的临床价值

doi:10.3969/j.issn.1004-583X.2024.08.003

摘要/Abstract

摘要：

目的探讨不同超声评估方法在左前降支(left anterior descending,LAD)狭窄中的临床价值。方法回顾性分析我院2023年04月至2024年04月经冠状动脉造影(coronary angiography,CAG)确诊,且行室壁运动分析、速度向量成像(velocity vector imaging,VVI)、冠状动脉血流成像(coronary flow imaging,CFI)3种不同超声评估方法的240例患者的超声资料。按照LAD狭窄程度分为试验组(狭窄≥50%)120例、对照组(狭窄<50%)120例,总结两组室壁运动分析、VVI、CFI超声特征,并以CAG为金标准,分析3种不同超声评估方法的诊断效能。结果室壁运动分析显示试验组室壁运动异常比例高于对照组;VVI显示试验组前间隔和前壁收缩期纵向应变低于对照组;CFI显示试验组LAD的舒张期峰值速度快于对照组,差异均有统计学意义(P<0.05)。以CAG结果为金标准,室壁运动分析诊断LAD狭窄≥50%敏感度为0.467、特异度为0.717、准确度为0.591、阳性预测值为0.622、阴性预测值为0.573;VVI诊断LAD狭窄≥50%敏感度为0.800、特异度为0.817、准确度为0.808、阳性预测值为0.813、阴性预测值为0.803;CFI诊断LAD狭窄≥50%敏感度为0.850、特异度为0.783、准确度为0.817、阳性预测值为0.796、阴性预测值为0.839。一致性检验结果显示,室壁运动分析与CAG一致性一般,Kappa值为0.183,VVI、CFI与CAG一致性较高,Kappa值分别为0.617、0.633。受试者工作特征曲线分析显示室壁运动分析、VVI、CFI的曲线下面积分别为0.592、0.808、0.817。结论前间隔及前壁运动异常、前间隔及前壁收缩期纵向应变减低、LAD的舒张期峰值速度加速是LAD狭窄时室壁运动分析、VVI、CFI的超声特征,均可作为诊断依据,但前者的诊断效能明显低于后两者,VVI和CFI诊断LAD狭窄具有较高的诊断效能,且与CAG一致性较好,值得临床应用与推广。

方法

关键词: 冠状动脉狭窄, 室壁运动分析, 速度向量成像, 冠状动脉血流成像

Abstract:

Objective To explore the clinical value of different ultrasound methods in assessing the left anterior descending artery (LAD) stenosis. Methods A retrospective analysis was conducted on the ultrasound data of 240 patients diagnosed as the LAD stenosis by coronary angiography (CAG) in our hospital from April 2023 to April 2024, who underwent three different ultrasound evaluation methods, including ventricular wall motion analysis, velocity vector imaging (VVI), and coronary artery flow imaging (CFI). According to the degree of LAD stenosis, patients were divided into the experimental group (stenosis≥50%, n=120) and control group (stenosis<50%, n=120). The wall motion analysis, VVI, and CFI ultrasound characteristics of patients in the two groups were summarized, and the diagnostic efficacy of three different ultrasound methods was analyzed using CAG as the gold standard. Results Wall motion analysis showed that the proportion of regional wall motion abnormalities in the experimental group was significantly higher than that of the control group (P<0.05). VVI showed that the longitudinal peak strain of the anterior interval and anterior wall contraction period in the experimental group was significantly lower than that of the control group (P<0.05). CFI showed that the diastolic peak velocity of LAD in the experimental group was significantly faster than that of the control group (P<0.05). Using the CAG results as the gold standard, the sensitivity of wall motion analysis for diagnosing LAD stenosis≥50% was 0.467, with the specificity of 0.717, accuracy of 0.591, positive predictive value (PPV) of 0.622, and negative predictive value (NPV) of 0.573. VVI in diagnosing LAD stenosis≥50% had a sensitivity of 0.800, specificity of 0.817, accuracy of 0.808, PPV of 0.813, and NPV of 0.803. CFI in diagnosing LAD stenosis≥50% had a sensitivity of 0.850, specificity of 0.783, accuracy of 0.817, PPV of 0.796, and NPV of 0.839. The consistency test results showed that the consistency between wall motion analysis and CAG was average, with a Kappa value of 0.183. VVI, CFI, and CAG showed a high consistency, with Kappa values of 0.617 and 0.633, respectively. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of wall motion analysis, VVI, and CFI in diagnosing LAD stenosis was 0.592, 0.808, and 0.817, respectively. Conclusion Abnormal anterior septal and anterior wall motion, decreased anterior septal and anterior wall longitudinal peak strain, and diastolic peak velocity acceleration of LAD are all diagnostic criteria of wall motion analysis, VVI, and CFI for LAD stenosis. However, the diagnostic efficacy of the former one is significantly lower than the latter two. VVI and CFI have a high diagnostic efficacy in diagnosing LAD stenosis and good consistency with CAG, which is worthy of clinical application and promotion.

Key words: coronary stenosis, analysis of ventricular wall motion, velocity vector imaging, coronary artery blood flow imaging

中图分类号:

R543.3

李星, 冯华平, 蓝胜峰, 李志勇. 不同超声评估方法在左前降支狭窄中的临床价值[J]. 临床荟萃, 2024, 39(8): 693-699.

Li Xing, Feng Huaping, Lan Shengfeng, Li Zhiyong. Clinical value of different ultrasound methods in assessing the left anterior descending artery stenosis[J]. Clinical Focus, 2024, 39(8): 693-699.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.08.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I8/693

图/表 9

表1 两组不同超声评估方法超声特征比较

Tab.1 Ultrasound characteristics of different ultrasound evaluation methods between groups

组别	例数	RWMA [例(%)]	LPS(%)		PDV (m/s)
组别	例数	RWMA [例(%)]	前间隔	前壁	PDV (m/s)
试验组	120	76(63.3)	16.46±4.23	17.63±4.68	0.97±0.13
对照组	120	22(18.3)	24.13±5.12	26.58±4.87	0.35±0.11
χ²/ $t$ 值		50.290	-11.217	-12.316	28.278
$P$ 值		<0.001	<0.001	<0.001	<0.001

表1 两组不同超声评估方法超声特征比较

Tab.1 Ultrasound characteristics of different ultrasound evaluation methods between groups

组别	例数	RWMA [例(%)]	LPS(%)		PDV (m/s)
组别	例数	RWMA [例(%)]	前间隔	前壁	PDV (m/s)
试验组	120	76(63.3)	16.46±4.23	17.63±4.68	0.97±0.13
对照组	120	22(18.3)	24.13±5.12	26.58±4.87	0.35±0.11
χ²/ $t$ 值		50.290	-11.217	-12.316	28.278
$P$ 值		<0.001	<0.001	<0.001	<0.001

图1 试验组心尖长轴切面应变图像

Fig.1 Apical long-axis strain images of the experimental group

图2 试验组心尖两腔切面应变图像

Fig.2 Apical two-chamber view strain images of the experimental group

图3 试验组LAD血流频谱图像

Fig.3 Spectral image of LAD blood flow in the experimental group

图4 对照组心尖长轴切面应变图像

Fig.4 Apical long-axis view strain images of the control group

图5 对照组心尖两腔切面应变图像

Fig.5 Apical two-chamber view strain images of the control group

图6 对照组LAD血流频谱图像

Fig.6 Spectral images of LAD blood flow of the control group

表2 不同超声评估方法的诊断效能分析

Tab.2 Diagnostic efficacy analysis of different ultrasound evaluation methods

方法	AUC	Kappa	敏感度	特异度	准确度	阳性预测值	阴性预测值
室壁运动分析	0.592	0.183	0.467	0.717	0.591	0.622	0.573
VVI	0.808	0.617	0.800	0.817	0.808	0.813	0.803
CFI	0.817	0.633	0.850	0.783	0.817	0.796	0.839

图7 不同超声评估方法的ROC曲线

Fig.7 ROC curves of different ultrasound assessment methods

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