cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.n692cardio-692Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESВозможности и ограничения трехмерной чреспищеводной эхокардиографии в диагностике атеросклероза грудного отдела аортыPossibilities and limitations of three-dimensional transesophageal echocardiography in the diagnosis of thoracic aorta atherosclerosishttps://orcid.org/0000-0002-7981-8547ВрублевскийА. В.VrublevskyA. V.

634012, Томск, ул. Киевская, д. 111а

SPIN-код 2028-9740

Kievskaya 111a, Tomsk 634012

SPIN 2028-9740

avr@cardio-tomsk.ruБощенкоА. А.BoshchenkoA. A.

634012, Томск, ул. Киевская, д. 111а

SPIN-код 5310-5908

Kievskaya 111a, Tomsk 634012

SPIN 5310-5908

bosh@cardio-tomsk.ruБогдановЮ. И.BogdanovYu. I.

Kievskaya 111a, Tomsk 634012

SPIN 9750-1314

yuri-bogdanov@mail.ruФГБНУ «Томский НИМЦ», «НИИ кардиологии»РоссияTomsk National Research Medical Center of the Russian Academy of Science, Cardiology Research InstituteRussian Federation2019110920195910S2230Copyright © Kardiomag, 20192019KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/692

Цель исследования. Сравнение возможностей и ограничений двухмерной (2D) и трехмерной (3D) мультиплановой чреспищеводной эхокардиографии в диагностике стадии атеросклероза грудного отдела аорты (ГА), количественной оценке аортальных атером и их геометрии, а также предикции коронарного атеросклероза. Материал и методы. 2D и 3D мультиплановое чреспищеводное ультразвуковое исследование (ЧПУЗИ) ГА выполнено у 180 больных с типичной или вероятной стенокардией (104 мужчины, 76 женщин, средний возраст 62,4±7,5 лет) на ультразвуковой диагностической системе IE33 xMatrix (Philips) с помощью матричного чреспищеводного датчика X7-2t. В 2D режиме визуализировали восходящий отдел, доступные для локации участки дуги и весь нисходящий отдел ГА по стандартному протоколу, применяя технологию сканирования xPlane. 3D исследование выполняли, применяя режимы Live 3D и Full Volume. 2D и 3D исследования записывали в виде серии видеоклипов на жесткий диск прибора с последующей off-line обработкой на рабочей станции QLab 10.8 (Philips). Измеряли высоту (см) и визуально оценивали контур каждой атеромы в 2D и 3D режимах. Выделяли 5 стадий атероматоза ГА: 1 – утолщение комплекса интима-медия <2 мм; 2 – локальное или диффузное утолщение комплекса интима-медия 2-3 мм (мелкие атеромы); 3 – атеромы высотой >3-5 мм без мобильного или ульцерогенного компонентов; 4 – атеромы высотой >5 мм без мобильного или ульцерогенного компонентов; 5 – атеромы любой высоты с мобильным или ульцерогенным компонентом. После ЧПУЗИ ГА всем обследованным больным выполнена диагностическая цифровая коронарная ангиография. У 122 (67,7%) больных, не имеющих стентов в коронарных артериях и коронарных шунтов, рассчитан SYNTAX Score. Результаты. Всего проанализировано 620 атером: 109 (17,6%) в восходящем отделе, 8 (1,3%) в дуге и 503 (81,1%) в нисходящем отделе ГА. В среднем у одного больного выявлено 3,4±2,1 атеромы в различных отделах ГА. Высота атером в 3D изображении была статистически значимо выше (p<0,001), чем в 2D, составляя 0,38±0,09 см и 0,26±0,07 см, соответственно. Усредненный прирост высоты атером в 3D режиме составил 0,12±0,06 см. В 3D изображении 87,7% атером демонстрировали неровные контуры, в то время как в 2D изображении неровность контуров имели только 35,4% атером. Мобильный компонент у 6 (66,6%) из 9 осложненных атером выявлен только в 3D изображении. В 2D режиме стадии атероматоза ГА 1-5 выявлены в 22 (12,2%), 103 (57,2%), 43 (23,9%), 7 (3,9%), и 4 (2,2%) случаях, соответственно. В 3D режиме стадии атероматоза ГА 1-5 выявлены в 16 (8,9%), 25 (13,9%), 90 (50%), 38 (21,1%) и 10 (5,5%) случаях, соответственно. При этом 130 (72,2%) больных в 3D изображении демонстрировали стадию атероматоза ГА более высокой градации. У 1 (0,6%) больного атероматоз ГА не выявлен. Установлена прямая корреляция между стадией атероматоза ГА и SYNTAX Score, составившая для 2D режима rs=0,32; p<0,001 и 3D режима rs=0,30; p<0,01, соответственно. Заключение. 3D чреспищеводное ультразвуковое исследование ГА является более точным методом количественной оценки атеросклеротических бляшек и их геометрии, диагностики осложненных атером и стадии атеросклероза, чем 2D исследование, что позволяет, в конечном итоге, изменить стадию атероматоза в сторону более высокой градации. 3D ультразвуковая стадия атероматоза ГА является информативным предиктором выраженности и распространенности коронарного атеросклероза.

Objectives. To compare the possibilities and limitations of the two-dimensional (2D) and three-dimensional (3D) multiplane transesophageal echocardiography (TEE) for the diagnosis of the thoracic aorta (TA) atherosclerosis stage, qualitative and quantitative assessment of aortic atheromas and coronary atherosclerosis prediction. Materials and methods. 2D and 3D multiplane TEE of the TA was performed in 180 consecutive CAD patients (104 men, 76 women, mean age 62,4±7,5 years) using Philips IE33 xMatrix system and a X7-2t multiplane probe. Ascending aorta, accessible parts of the arch and descending TA were visualized in 2D mode with standard protocol using Live xPlane mode. 3D study of TA was performed using Live 3D and Full Volume modes. 2D and 3D studies were recorded as video clips series on a system hard drive with subsequent off line processing on a QLab 10.8 (Philips) workstation. Qualitative and quantitative assessment of every atheroma was performed using 2D and 3D modes. The degree of severity and distribution of the TA atheromatosis was evaluated according to the classification of ASE and EACVI (2015): grade 0 – intimal-medial thickness ≤1 mm, 1 – intimal thickness ≤2 mm, 2 – focal or diffuse intimal thickening of 2-3 mm (small atheromas), 3 – atheromas >3–5 mm (no mobile/ulcerated components), 4 - atheromas > 5 mm (no mobile/ulcerated components), 5 - grade 2, 3, or 4 atheromas plus mobile or ulcerated components. After TEE all patients underwent digital coronary angiography. SYNTAX Score was calculated in 122 (67,7%) patients with no coronary stents and bypass grafts. Results. 620 atheromas were analysed: 109 (17,6%) in the ascending part, 8 (1,3%) in the arch and 503 (81,1%) in the descending part. On average 3,4±2,1 atheromas per patient were revealed. Atheromas height in 3D was significantly higher (p<0,001), than in 2D, being 0,38±0,09 cm and 0,26±0,07 cm, respectively.  Averaged atheromas height increase in 3D was 0,12±0,06 cm. In 3D 87,7% of atheromas have shown irregular contours while in 2D only 35,4% of atheromas had rough countors. The mobile component in 6 (66,6%) out of 9 atheromas was revealed only in 3D. In 2D 1-5 stages of TA atheromatosis were revealed in 22 (12,2%), 103 (57,2%), 43 (23,9%), 7 (3,9%) and 4 (2,2%) cases, respectively. In 3D 1-5 stages of TA atheromatosis were revealed in 16 (8,9%), 25 (13,9%), 90 (50%), 38 (21,1%) and 10 (5,5%) cases, respectively. With 3D TEE 130 (72,2%) patients were found to have higher gradation of TA atheromatosis stage. TA atheromatosis was not detected in 1 (0,6%) patient. The direct Spearman’s correlation between a stage of TA atheromatosis and SYNTAX Score which has been established for 2D rs =0,32 p<0,001 and 3D rs =0,30, p<0,01, respectively. Conclusion. A comparison between 2D and 3D TEE has shown, that 3D is more precise method of qualitative and quantitative assessment of aortic atheromas and diagnosis of TA atheromatosis stage which allows, ultimately, to change the stage of TA atheromatosis towards a higher gradation. 3D ultrasound stage of TA atheromatosis is a surrogate marker of the severity and prevalence of coronary atherosclerosis.

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The authors declare that there are no conflicts of interest present.