Online Journal
IF値: 0.677(2017年)→0.966(2018年)


Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.05

Original Article(原著)

(0649 - 0654)


Accuracy of speckle tracking echocardiography for diagnosis of myocardial ischemia: a comparison between 2-dimensional and 3-dimensional methods

浅沼 俊彦, 岡 雅通, 増田 佳純, 櫻井 大輔, 中谷 敏

Toshihiko ASANUMA, Masamichi OKA, Kasumi MASUDA, Daisuke SAKURAI, Satoshi NAKATANI


Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine

キーワード : early systolic lengthening, echocardiography, myocardial strain, post-systolic shortening

目的:スペックルトラッキング法を用いた心筋ストレイン解析により,収縮期最大ストレインだけでなく,early systolic lengthening(ESL)やpost-systolic shortening(PSS)といった微細な心筋運動も容易に評価できるようになった.二次元(2D)法では,これらの微細運動評価により,虚血診断精度が改善すると報告されているが,三次元(3D)法での有用性は不明である.本研究では,2Dおよび3D法において,収縮期最大ストレインと比べて,このような微細心筋運動の評価が虚血診断精度を改善するかを検討した.対象と方法:麻酔開胸犬20頭を用い,左冠動脈回旋枝の狭窄前,20‐40%の血流低下時(狭窄1),60‐80%の血流低下時(狭窄2)に,2D法または3D法による画像を取得した.虚血領域の収縮期最大ストレイン,ESL,PSSを計測し,ROC解析の曲線下面積(AUC)から,各指標の狭窄1と狭窄2の診断精度を求めた.結果:2D法のAUCは,狭窄2診断では,すべての指標でAUC=0.5と比べて有意に高値であったが,狭窄1診断では,PSSのみが有意に高値であった(AUC: 収縮期最大ストレイン=0.70,ESL=0.72,PSS=0.87).一方,3D法のAUCは,2D法と比べると低く,狭窄1診断では,どの指標も有意ではなかった(AUC: 収縮期最大ストレイン=0.64,ESL=0.51,PSS=0.61).結論:スペックルトラッキング法による虚血診断において,2D法は3D法よりも優れた診断精度を示した.PSSによる診断は,2D法では収縮期最大ストレインよりも優れていたが,3D法ではその優位性は示されなかった.

Purpose: Subtle myocardial deformations such as early systolic lengthening (ESL) and post-systolic shortening (PSS) seem to be useful for detecting myocardial ischemia by 2-dimensional (2D) speckle tracking echocardiography. However, it is still unclear whether the same holds true for the 3-dimensional (3D) method. We therefore evaluated the accuracy of 2D and 3D speckle tracking echocardiography for the diagnosis of myocardial ischemia using an experimental model. Subjects and Methods: In 20 open-chest dogs, 2D or 3D echocardiographic images were acquired before flow reduction of the left circumflex artery, during 20-40% of flow reduction (stenosis 1) and 40-60% of flow reduction (stenosis 2). Peak systolic strain, early systolic lengthening, and post-systolic shortening were analyzed in the ischemic region, and the area under the curve (AUC) of the receiver operating characteristic curve for diagnosing each stenosis was calculated. Results: With the 2D method, the AUC of all parameters was significantly larger than the line of no information (AUC=0.5) in the case of stenosis 2; however, only the AUC of PSS was significant in the case of stenosis 1 (AUC: peak systolic strain=0.70, ESL=0.72, PSS=0.87). With the 3D method, the AUC of all parameters tended to be smaller than that yielded by the 2D method. Neither ESL nor PSS was significant in the case of stenosis 1 (AUC: peak systolic strain=0.64, ESL=0.51, PSS=0.61). Conclusion: 2D speckle tracking echocardiography provided better diagnostic accuracy for detecting myocardial ischemia than the 3D method. The assessment of PSS was superior to that of peak systolic strain with the 2D method but not with the 3D method.