【摘要】 目的采用左心室二维斑点追踪成像(2D-STI)评价川崎病患儿的冠状动脉病变。方法诊断准确性研究。回顾性收集川崎病合并冠状动脉病变患儿以选择性冠状动脉造影(CAG)为金标准,以经胸二维超声心动图(2D-TTE)和左心室2D-STI为待测标准,评价待测标准诊断冠状动脉病变的准确性。结果完成CAG和2D-STI检查的川崎病连续患儿24例,起病年龄中位数为15(1～125)个月,行2D-TTE和CAG检查的中位时间分别为病程4(1～97)个月和6(2～97)个月。CAG检查结果:Ⅲ级冠状动脉病变4例,Ⅳ级冠状动脉病变12例(3例合并血栓),Ⅴb级冠状动脉病变8例; 11例高级别冠状动脉病变中,累及左回旋支、左前降支和右冠状动脉分别为2、5和11例。2D-TTE诊断高级别冠状动脉病变13例,左冠主干、左回旋支、左前降支、右冠近段、右冠远段高级别病变节段数分别为0、1、12、5和4个。2D-STI检测左心室收缩纵向应变峰值平均值异常10例,均诊断为高级别冠状动脉病变,其中左回旋支、左前降支、右冠状动脉节段数分别为5、6和4个。2D-TTE诊断左回旋支、左前降支、右冠状动脉高级别病变真阳性分别为0、4和5例,假阴性分别为2、1和6例;与CAG完全匹配患儿11例,其中高级别冠状动脉病变患儿2例,低级别冠状动脉病变患儿9例;部分匹配4例;错误判断9例。2D-STI诊断左回旋支、左前降支、右冠状动脉高级别病变真阳性分别为1、4和4例,假阴性分别为1、1和7例;与CAG完全匹配患儿13例,其中高级别冠状动脉病变患儿3例,低级别冠状动脉病变患儿10例;部分匹配2例;错误判断9例。结论 2D-TTE和2D-STI诊断川崎病高级别冠状动脉病变患儿能力一般; 2D-STI诊断左回旋支、左前降支冠状动脉节段病变优于2D-TTE,而诊断右冠状动脉节段病变差于2D-TTE。更多还原

【Abstract】 Objective To evaluate coronary artery lesions in children with Kawasaki disease using left ventricular 2 D-speckle tracking imaging( 2 D-STI). Methods Selective coronary angiography( CAG) was used as the gold standard,and 2 D transthoracic echocardiography( 2 D-TTE) and left ventricular 2 D-STI were used as the criteria to evaluate the diagnostic accuracy of high-level coronary lesions in Kawasaki disease. Results Kawasaki disease was diagnosed in 24 consecutive patients with CAG and 2 D-STI.The median age of onset was 15( 1-125) months. The median time of echocardiography and CAG examination was 4( 1-97) months and 6( 2-97) months,respectively. CAG results showed 4 cases of grade Ⅲ coronary artery lesions,12 cases of grade Ⅳ coronary artery lesions,and 8 cases of grade Ⅴ b coronary artery lesions. Among the 11 cases of high-grade coronary artery lesions,there were 2 cases involving the left circumflex branch( LCX),11 cases involving the left anterior descending branch( LAD) and 5 cases involving the right coronary artery( RCA). There were 13 cases of high grade coronary lesions diagnosed by 2 D-TTE,and the number of high grade lesions in the left main coronary artery,LCX,LAD,proximal RCA,and distal RCA was 0,1,12,5 and 4,respectively. 2 D-STI detected abnormal MLS in 10 patients,all of whom were diagnosed as high-grade coronary lesions,among which the number of LCX,LAD and RCA was 5,6 and 4,respectively. There were 0,4 and 5 true positive cases of LCX,LAD and RCA lesions diagnosed by 2 D-TTE,and 2,1 and 6 false negative cases,respectively. Eleven children were completely matched with CAG,including 2 children with high-grade coronary artery lesions and 9 children with low-grade coronary artery lesions. There were 4 cases of partial matching and 9 cases of wrong diagnosis. There were 1,4 and 4 true positive cases of LCX,LAD and RCA lesions diagnosed by 2 D-STI,and 1,1 and 7 false negative cases. Thirteen children were completely matched with CAG,including 3 children with high-grade coronary artery lesions and 10 children with low-grade coronary artery disease. There were 2 cases of partial match and 9 cases of wrong diagnosis. Conclusion The diagnostic efficiency of 2 D-TTE and 2 D-STI in children with high grade coronary artery lesions of Kawasaki disease is average. 2 D-STI was superior to 2 D-TTE in the diagnosis of LCX and LAD lesions,while in the diagnosis of RCA lesions 2 D-STI was inferior to 2 D-TTE.更多还原