目的运动负荷5min后,用舒张期应变超声心动图法检测心肌缺血引起的左室局部舒张功能碍障,客观的判定局部心肌缺血。方法对32例疑似缺血性心脏病患者在运动负荷前及负荷5min后,分别各室壁中间段合计6个左室节段上获取应变曲线。在各节段中,测定舒张应变指数(SDI)再计算出能反映运动负荷前后舒张应变指数变化的运动负荷前后SDI比,以运动负荷心肌同位素扫描所显示冠状动脉所支配心肌缺血部位做为判定比较基准,根据运动负荷前后SDI比探讨心肌缺血。结果在32例患者心肌的174节段中,检测出126个非缺血节段,48个缺血节段,与运动负荷心肌同位素扫描比较结果相一致,其中非缺血节段负荷前后SDI无显著的差异,而缺血节段负荷前后SDI值差异有统计学意义,非缺血126个节段与缺血48个节段之间,运动负荷前后SDI差异有统计学意义,与运动负荷同位素相对照后,运动负荷前后SDI比的临界值为0.51时,敏感度为91%,特异性为89%,用此方法可以判定心肌缺血。结论应用舒张期应变超声心动图法在运动负荷5min后,能检测到由于心肌缺血所产生的局部舒张期功能障碍,判定左室局部心肌缺血。 Objective 5min after exercise load, diastolic strain echocardiography was used to detect left ventricular regional diastolic dysfunction caused by myocardial ischemia, objectively determine the local myocardial ischemia. Methods 32 patients with suspected ischemic heart disease before exercise load and load 5min, the middle of each wall of the total of 6 left ventricular segment strain curve was obtained. In each segment, the SDI was measured before and after exercise load to measure the change of diastolic strain index (SDI) before and after exercise load, and the myocardial infarction area of ​​coronary artery showed by exercise load myocardial isotope scan was taken as To determine the baseline, according to exercise load before and after the SDI than myocardial ischemia. Results A total of 126 non-ischemic segments and 48 ischemic segments were detected in 174 segments of myocardium of 32 patients, which were consistent with myocardial load isotope scan. The non-ischemic segments before and after SDI Significant differences were found between the pre-and post-ischemic segments of SDI. There was significant difference between the non-ischemic 126 segments and the ischemic segments of 48 segments before and after exercise load SDI difference was statistically significant, and exercise load isotope After contrast, the critical value of SDI before and after exercise load was 0.51, the sensitivity was 91% and the specificity was 89%. Myocardial ischemia could be judged by this method. Conclusions The diastolic strain echocardiography can be used to detect the local diastolic dysfunction caused by myocardial ischemia after 5min exercise load to determine the left ventricular regional myocardial ischemia.