摘要目的：探讨实时三维斑点追踪成像（real‐time three‐dimentional speckle tracking imaging ， RT‐3D‐STI）技术早期检测无节段性室壁运动异常的冠状动脉动脉狭窄患者左室整体及局部心肌收缩功能的价值。方法根据冠状动脉造影结果，将64例常规超声检查无节段性室壁运动异常的冠状动脉狭窄患者分为2组：无冠状动脉狭窄组（20例）和冠状动脉狭窄组（44例），并将所有患者心肌节段分为5组：无冠状动脉狭窄组正常心肌节段、冠状动脉狭窄组正常心肌节段、轻度冠状动脉狭窄心肌节段、中度冠状动脉狭窄心肌节段和重度冠状动脉狭窄心肌节段。经胸采集三维全容积图像，获得左室整体面积应变（GAS ）及17个心肌节段的面积应变（AS）等参数，比较无冠状动脉狭窄组与冠状动脉狭窄组间及不同程度冠状动脉狭窄心肌节段间各参数的差异，分析GAS与冠状动脉Gensini积分的相关性。结果与无冠状动脉狭窄组相比，冠状动脉狭窄组GAS明显减低（ P ＜0.05）。心肌节段AS随冠状动脉狭窄程度的加重呈减低趋势，无冠状动脉狭窄组正常心肌节段、冠状动脉狭窄组正常心肌节段及轻度冠状动脉狭窄心肌节段 AS之间差异无统计学意义（P ＞0.05），与其相比，中度及重度冠状动脉狭窄心肌节段 AS明显减低（P ＜0.05），且重度冠状动脉狭窄心肌节段 AS 低于中度冠状动脉狭窄心肌节段，差异有统计学意义（ P ＜0.05）。GAS与冠状动脉Gensini积分之间显著相关（ r ＝08．28，P ＜0.01）。结论 RT‐3D‐STI技术能够定量评价冠状动脉狭窄患者早期左室整体及局部心肌收缩功能的变化，可靠性高。

abstractsObjective To explore the value of real‐time three‐dimensional speckle tracking imaging (RT‐3D‐STI) in the early detection of globle and regional left ventricular myocardial systolic function in patients of coronary stenosis without regional wall motion abnormality. Methods 64 coronary stenosis patients without regional wall motion abnormality were divided into 2 groups according to angiography (CAG):without coronary stenosis group( n = 20) and coronary stenosis group ( n = 44), and all the myocardial segments of the patients were divided into 5 groups:without coronary stenosis group normal myocardial segments ( n = 340 ), coronary stenosis group normal myocardial segments ( n = 235 ), mild coronary stenosis myocardial segments( n = 126), moderate coronary stenosis myocardial segments( n =213) and severe coronary stenosis myocardial segments( n =174). Real‐time three‐dimensional full volume of left ventricle was obtained, left ventricular global area strain (GAS)and regional area strain(AS) of 17 myocardial segments, etc, were measured by RT‐3D‐STI respectively. The parameters between the two groups and among the five sub groups were compared, the correlation between GAS and coronary artery Gensini score was also analyzed. Results GAS in coronary stenosis group significantly reduced compared with without coronary stenosis group( P <0 0.5) S.egmental AS gradually reduced with the increasing of the degree of the coronary stenosis. There was no statistically difference of segmental AS among without coronary artery group normal myocardial segments, coronary stenosis group normal myocardial segments and mild coronary stenosis myocardial segments( P >0 0.5) S.egmental AS in moderate and severe coronary stenosis myocardial segments significantly reduced ( P < 0.05 ), and that in severe coronary stenosis myocardial segments was lower than that in moderate coronary stenosis myocardial segments, the differences were statistically significant ( P < 0.05 ). In addition, GAS was significantly correlated with coronary artery Gensini score( r =0.828, P <0.01). Conclusions RT‐3D‐STI can quantitatively assess the early changes of left ventricular globle and regional myocardial systolic function in patients with coronary stenosis.