Abstract: Background　The pathophysiological mechanism of cardiac syndrome X （CSX） is still not clear.Evaluation data of female ischemic syndrome shows that in coronary angiography，about 50% of women and 17% of men do not have stenosis or coronary artery stenosis <50%.Compared with normal population，CSX patients have a higher incidence of myocardial infarction and stroke.As CSX is easy to progress，coronary lesions tend to be aggravated，so it is particularly important to seek a new evaluation method．Objective　To evaluate the left ventricular systolic function （LVSF） in patients with cardiac syndrome X using three-dimensional speckle tracking imaging （3D-STI）．Methods　The enrolled 60 participants were all from Huzhou Central Hospital from June 2016 to September 2017，including 40 cardiology inpatients with typical chest pain，positive results of treadmill exercise testing but without coronary artery anomalies （identified by coronary arteriongraphy） （study group），and other 20 healthy individuals underwent physical examination in the outpatient （control group）．Echocardiography was performed for examining the left ventricular diastolic and systolic function parameters.Using 3D-STI，the peak values of longitudinal strain （LS），radial strain （RS），circumferential strain （CS），and area strain （AS），and the peak of twist angle （Ptw） and torsion of the left ventricle were measured．Results　LVEDD，LVESD，E/A，E/E'，S'，LVEF were similar in both groups （P>0.05）.RS and CS were similar in both groups （P>0.05），but LS and AS reduced，and Ptw and torsion of the left ventricle increased significantly in the study group （P<0.05）．Univariate Logistic regression analysis showed that LS 〔OR=0.520，95%CI（0.310，0.875）〕 and AS 〔OR=0.463，95%CI（0.280，0.764）〕 were the influencing factors of CSX （P<0.05）；for diagnosing CSX，the AUC of LS was 0.839 and that of AS was 0.853．Conclusion　Using 3D-STI can correctly evaluate the systolic function of different segments of the left ventricle in the normal population or in the CSX population.Moreover，as 3D-STI can detect early abnormal changes in myocardium such as ischaemic myocardium more timely and sensitively than echocardiography，it is recommended for clinical application.
Microvascular angina；Echocardiography，three-dimensional；Ventricular function，left

摘要： 背景　心脏X综合征（CSX）病理生理机制目前仍然不十分明确，在女性缺血综合征评估研究中，有数据表明在冠状动脉造影中约50%的女性及17%的男性无冠状动脉狭窄或狭窄程度<50%。与正常人群比较，CSX患者的心肌梗死与脑卒中发病率更高，由于CSX容易进展，冠状动脉病变容易加重，故寻求一种新的评估手段就显得尤为重要。目的　利用三维斑点追踪显像技术对CSX患者左心室收缩功能进行评价。方法　选取2016年6月—2017年9月入住湖州市中心医院心内科表现为典型胸痛、运动平板试验阳性但冠状动脉造影显示冠状动脉无明显异常的40例CSX患者为研究组，另选取同期门诊体检健康者20例为对照组，利用常规超声心动图检查左心室舒张功能及收缩功能指标，同时利用三维斑点追踪显像技术分析两组左心室纵向、径向、圆周、面积应变，同时测定左心室整体扭转角度及扭矩。结果　两组左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左房室瓣口舒张早期血流峰值（E）/左房室瓣口舒张晚期血流峰值（A）、E/左房室瓣环舒张早期运动速度（E'）、左房室瓣环室间隔侧收缩期峰值（S'）、左心室射血分数（LVEF）比较，差异均无统计学意义（P>0.05）。两组径向应变、圆周应变比较，差异均无统计学意义（P>0.05）；研究组纵向应变、面积应变较对照组降低，扭转角度、扭矩较对照组升高（P<0.05）。单因素Logistic回归分析结果显示，纵向应变〔OR=0.520，95%CI（0.310，0.875）〕、面积应变〔OR=0.463，95%CI（0.280，0.764）〕是CSX的影响因素（P<0.05）。纵向应变诊断CSX的受试者工作特征（ROC）曲线下面积为0.839，面积应变诊断CSX的ROC曲线下面积为0.853。结论　利用三维斑点追踪显像技术评估CSX患者左心室收缩功能，能有效评定左心室各节段收缩功能，与正常人群相比，在常规超声无法发现早期改变的情况下，可更早并更敏感地检测出局部缺血心肌，用来指导临床实践。

关键词: 微血管性心绞痛；超声心动描记术, 三维；心室功能, 左