实时三维超声心动图评价冠心病患者经皮冠状动脉介入治疗后左心室收缩同步性及心功能的早期改变  

Assessment of the changes in left ventricular systolic synchrony and cardiac function with coronary heart disease after primary percutaneous coronary intervention by real-time three-dimensional echocardiography

作　　者：魏常华[1] 袁建军[1] 朱好辉[1] 

机构地区：[1]河南省人民医院超声科,郑州450003

出　　处：《中华医学超声杂志（电子版）》2011年第11期2345-2353,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用实时三维超声心动图评价冠心病患者经皮冠状动脉介入(PCI)治疗后左心室收缩同步性及心功能的早期改变。方法对35例行PCI治疗的冠心病患者于术前及术后3d、1个月进行经胸二维和实时三维超声心动图检查,二维超声获得左心室射血分数(LVEF)、左心室舒张末内径(LVIDd)、左心室收缩末内径(LVIDs)、二尖瓣口舒张早期峰值流速(E)和舒张晚期峰值流速(A)及其比值(E/A);三维超声获得左心室容积时间曲线,计算或采集左心室舒张末容积(EDV)、左心室收缩末容积(ESV)、左心室射血分数(LVEF)、峰值射血率(PER)和峰值充盈率(PFR)及其容积校正值PER1和PFR1、校正的16节段不同步指数Tmsv16-SD%和Tmsv16-Dif%。结果三维超声参数:冠心病患者术前、术后3d、1个月EDV分别为(115.74±22.27)、(110.51±20.44)、(110.26±27.55)mL,组间比较差异无统计学意义(F=0.59,P>0.05);ESV分别为(53.57±22.63)、(44.28±14.34)、(44.00±15.08)mL,LVEF分别为(56.48±10.12)%、(60.45±7.91)%、(61.77±6.63)%,PER1分别为(3.10±0.80)、(3.37±0.47)、(3.43±0.52),PFR1分别为(2.01±0.51)、(2.16±0.39)、(2.34±0.44),Tmsv16-SD%分别为(2.33±2.32)、(1.61±0.83)、(1.22±0.87),Tmsv16-Dif%分别为(9.84±3.20)、(6.34±3.49)、(4.07±2.62),组间比较差异均有统计学意义(F=2.63、3.80、2.80、4.55、4.88、5.95,P均<0.05);冠心病患者术后3dLVEF、PER1、PFR1较术前均升高,但差异均无统计学意义(P均>0.05);冠心病患者术后3dESV、Tmsv16-SD%、Tmsv16-Dif%较术前均降低,差异均有统计学意义(t=1.98、2.00、1.98,P均<0.05);冠心病患者术后1个月ESV、Tmsv16-SD%、Tmsv16-Dif%较术前均降低,LVEF、PER1、PFR1较术前均升高,差异均有统计学意义(t=2.02、3.08、3.44、-2.65、-2.21、-3.02,P均<0.05)。二维超声参数:冠心病患者术前、术后3d、1个月LVIDd分别为(51.28±4.46)、(50.60±5.40)、(49.82±3.69)mm,E分别为(51.28±4.46)、(50.60±5.40)、(49.82±3.69)cm/s,A分别为(0.7Objective To assess the early changes in left ventricular systolic synchrony and cardiac function by real-time three-dimensional echocardiography(RT3DE)in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods Thirty-five subjects were selected and underwent RT3DE and two-dimensional echocardiography(2DE)1 day before treatment,3 days and one month after treatment.We measured left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVIDd),left ventricular end-systolic inlernal diameter(LVIDs),peak early(E)and late(A) trans-mitral Doppler velocities,and E/A ratio.The left ventricular volume-time curves(VTC),the left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),left ventricular ejection fraction(LVEF),peak ejection rate(PER),peak early filling rate(PFR),PER1=PER/EDV,PFR1=PFR/EDV,the time to minimal systolic volume of 16-segmental standard deviation and the maximum difference as a ratio of R-R interval(Tmsv16-SD% and Tmsv 16-Dif%)of RT3DE were obtained.Results RT3DE parameters:EDV of patients pre-treatment,3 days and one month after PCI were(115.74±22.27)mL,(110.51±20.44)mL and(110.26±27.55)mL respectively.The difference among the three groups was not statistically significant(F=0.59,P>0.05);ESV were(53.57±22.63)mL,(44.28±14.34)mL and(44.00±15.08)mL,LVEF were(56.48±10.12)%,(60.45±7.91)% and(61.77±6.63)%,PER1 were 3.10±0.80,3.37±0.47 and 3.43±0.52,PFR1 were 2.01±0.51,2.16±0.39 and 2.34±0.44,Tmsv16-SD% were 2.33±2.32,1.61±0.83 and 1.22±0.87,Tmsv16-Dif% were 9.84±3.20,6.34±3.49 and 4.07±2.62.The differences were all statistically significant(F=2.63,3.80,2.80,4.55,4.88,5.95,P<0.05);LVEF,PER1,PFR1 of 3 days after PCI treatment were larger than those before PCI,but the differences were not statistically significant(P>0.05);ESV,Tmsv16-SD%,Tmsv16-Dif% of 3 days after PCI treatment were lower than those before treatment.The differences were all statistically significant(t=1.98,2.00,1.98,P<0.05).ESV,Tmsv16-SD%,Tmsv16-Dif

关 键 词：三维超声心动描记术 左心室功能 经皮冠状动脉介入治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]