急性心肌梗死不同狭窄的非梗死相关血管局部心肌应力和应变率的变化  

The Changes of Regional Strain and Strain Rate in Segments of Acute Myocardial Infarction of the Non Infarct- Related Artery in Different Degree of Stenosis

作　　者：黄慧贤[1] 胡大一[2] 朱天刚[2] 吴旸[1] 郭实[1] 刘俊琪[1] 陈真[1] 丁茜[2] 王欣[2] 权欣[2] 

机构地区：[1]北京市海淀医院,北京100080 [2]北京大学人民医院,北京100044

出　　处：《中国医药导刊》2006年第1期24-27,共4页Chinese Journal of Medicinal Guide

摘　　要：目的：本试验主要观察急性心肌梗死(AMI)患者患病24小时内心肌各节段收缩相应力峰值(ε)和应变率峰值(SR)在不同血管直径的AMI非梗死相关血管(NIRA)供血节段的变化,并与正常人相应节段对比,探讨ε和SR在NIRA供血节段是否存在功能代偿；是否可以敏感发现危险区域。方法：以31例首次发病的AMI患者为研究对象,其中急性前壁心肌梗死(MI)14例,IRA为前降支(LAD)；急性下壁M117例,IRA为回旋支(LCX)10例,IRA为右冠状动脉(RCA)7例；所有病人均在发病24小时内获取其标准心尖二腔、长轴、四腔彩色组织多普勒图象,描记心肌各节段的应变成像(Strain)和应变率成像(SPI)曲线,测量基底段和中段部收缩相相关峰值。40例正常人作为对照同样测量相关数据。结果：NIRA狭窄程度＞50％时,AMI患者的SR与正常人相比,除前壁及前间隔中段外所有节段均有不同程度减低(P＜0.001、P＜0.01或P＜0.05),而AMI患者ε与正常人相比只有在NtRA狭窄程度＞70％时(前间隔中段除外)才有不同程度减低(P＜0.001、P＜0.01或P＜0.05),令人疑惑的是NIRA狭窄程度＜50％时出现反常的结果,ε及SA在大多数节段均有不同程度减低(P＜0.001、P＜0.01或P＜0.05),未发现代偿性功能增强。结论：Strain、SRI能够敏感、准确、定量、无创的评估NIRA＞50％以上狭窄的缺血心肌,为临床提供了可床旁测量、方便快捷的诊疗手段。Objective：This study was designed to measure peak value of strain （ε）and strain rate （SR）of patients with Acute myocardial infarction（AMI） during ejection time; and to investigate the exist of augmentation of systolic function in the territory of the non infarct - related artery. In the meanwhile, to observe the changes of ε or SR in segments of NIRA, we also sought to evaluate whether objective assessment of stenosis of coronary artery in different degree, using Strain or Strain Rate imaging （SRI） allows accurate and sensitive detection of risk resigons.Methods： The study population include 42 healthy volunteers and 31.patients with AMI（ 14 patients with anterior AMI and 17 patients with inferior AMI）. Among them, 14 patients＇ IRA was the left anterior descending coronary; 10 patients＇ IRA was Circonflex artery and 7 patients＇ IRA was right coronary artery. All patients were imaged within 24 - hour they got sick. 42 controls without any coronary artery or myocardial disease were also explored. After standard apical two - chamber, apical four - chamber and left ventricle long - axis views were acquired, myocardial ε and SR were calculated by Strain and SRI of each segment（basal and mid） .Results： Statistical significance were found in SR between majority NIRA segments with the finding of a 〉 50% luminal diameter narrowing and controls（P 〈 0. 001, P 〈 0.01 or P 〈 0.05）, but statistical significance were only found in ε between majority NIRA segments with the finding of a 〉 70%luminal diameter narrowing and controls（P 〈 0. 001, P 〈 0.01 or P 〈 0.05）. It was strange that statistical significance were found in SR between majority NIRA segments with the finding of a 〈 50% luminal diameter narrowing and controls （ P 〈 0.001, P 〈 0.01 or P 〈 0.05）, There was no augmentation of systolic function in the territory of the NiRA.Conclusion：ε and SR were a noninvasive, rapid, accurate and quantitative method that can be measured at bedside to assess

关 键 词：组织多普勒成像 应变力 应变率 心肌梗死 冠状动脉造影(CAG) 

分 类 号：R542.22[医药卫生—心血管疾病] R541[医药卫生—内科学]