Two dimensional speckle tracking echocardiography: clinical applications
Two dimensional speckle tracking echocardiography: clinical applications
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DOI：
10.1136/hrt.2010.199885
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发表时间：
2010-12-01
期刊：
影响因子：
5.7
通讯作者：
Binder, Thomas
中科院分区：
文献类型：
--
作者：
Blessberger, Hermann;Binder, Thomas
这篇综述是两篇关于二维斑点跟踪超声心动图（STE）的文章中的第二篇。虽然第一篇文章描述了STE的原理，但这篇综述涉及其潜在的临床应用。基于散斑跟踪的应变分析技术是一种较新的应变分析技术。然而，用组织多普勒成像（TDI）测量变形参数有相当多的经验。由于应变和应变率（SR）的测量结果与TDI的测量结果有很好的相关性，因此TDI所显示的许多结果可能适用于STE。由于STE与TDI相比具有许多优点（可重复性，完整的径向和周向应变、扭转、扭转和旋转分析），因此它为TDI提供了重要的信息。研究STE在临床和亚临床状况的出版物数量正在迅速增长，并证实了这项技术的潜力。本文综述了STE目前的经验，指出STE的潜在临床应用和未来发展，并描述了STE的局限性。超声心动图对冠状动脉疾病（CAD）的评估主要基于检测区域壁运动异常、心肌增厚缺乏和瘢痕组织的可见性。然而，这种方法是高度主观的，需要相当的操作员经验，并且强烈依赖于图像质量。尽管已经提出了几种不同的方法来量化局部壁运动异常，但这些方法都不够可靠，无法用于临床实践。TDI的经验表明，局部组织变形的分析提供了重要的附加信息，甚至可以量化缺血异常。缺血和瘢痕组织显示出峰值节段应变和SR的减少和延迟。这对于纵向、圆周和径向应变/SR分量都是如此。一个重要的附加现象发生在缺血发作后早期，可以用sted检测到收缩后增厚。收缩期后增厚可定义为主动脉瓣关闭后心肌仍持续增厚（图1）。
This review is the second of two articles that focus on two dimensional speckle tracking echocardiography (STE). While the first article described the principles of STE, this review deals with its potential clinical applications. The technology of speckle tracking based strain analysis is rather new. w1 w2 However, there is considerable experience with parameters of deformation measured with tissue Doppler imaging (TDI). Since measurements of strain and strain rate (SR) correlate well with those of TDI, much of what has been shown with TDI can probably be applied to STE. Because STE has numerous advantages compared to TDI (reproducibility, complete analysis of radial and circumferential strain, twist, torsion, and rotation), it adds important information to what is already known from TDI. The number of publications which investigate STE in clinical and subclinical conditions is rapidly growing and confirms the potential of this technology. This review summarises the current experience of STE, points to potential clinical applications and future developments of STE, and describes its limitations.STE AND CORONARY ARTERY DISEASE The echocardiographic assessment of coronary artery disease (CAD) is mainly based on the detection of regional wall motion abnormalities, lack of myocardial thickening, and visualisation of scar tissue. However, this approach is highly subjective, requires considerable operator experience, and strongly depends on image quality. Even though several different methods to quantify regional wall motion abnormalities have been proposed, none of these are robust enough to be used in clinical practice. The experience with TDI has shown that the analysis of regional tissue deformation provides important additional information and even allows quantification of ischaemic abnormalities. Ischaemic and scarred tissue shows a reduction and delay of peak segmental strain and SR. w3 w4 This is true for longitudinal, circumferential, and radial strain/SR components. w3 w4 An important additional phenomenondwhich occurs early after the onset of ischaemia and which can be detected with STEdis post-systolic thickening. Post-systolic thickening can be defined as continued myocardial thickening which is present even after aortic valve closure (figure 1).