急性心肌梗死直接经皮冠状动脉介入治疗术后左室舒张功能远期改变  

Long-term changes of left ventricular diastolic function in patients with acute myocardial infarction after primary percutaneous coronary intervention

作　　者：朱梦若 张跃力[1] 王曼[1] 郑东燕[1] 马新欣[1] 

机构地区：[1]上海交通大学附属第六人民医院超声医学科上海超声医学研究所,上海200233

出　　处：《中国循证心血管医学杂志》2015年第6期740-743,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：上海市科学技术委员会基金资助(134119a5801)

摘　　要：目的 探讨急性ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（pPCI）术后左室舒张功能（LVDF）远期变化。方法 连续入选2014年1月-2014年6月首次因急性STEMI在上海交通大学附属第六人民医院住院且成功行PCI术的患者36例,6个月随访时剔除3例,最后共纳入33例,其中男性28例,女性5例,年龄37-83岁,平均年龄（61±14）岁。分别于PCI术后24-48 h和6个月随访时采用超声心动图评价左室功能。观测指标：二尖瓣舒张期血流速度（E峰）、二尖瓣环舒张期运动速度（e＇）、左室射血分数（LVEF）及室壁运动记分指数（WMSI）,计算左室充盈指数E/e＇。结果 与pPCI术后24-48h相比,术后6个月时随访LVDF分级：14例（42.4%）有改善,5例（15.2%）恶化,14例（42.4%）无改变。术后6个月随访时,LVDF指标e＇[（10.5±3.6）cm/s vs.（8.6±2.1）cm/s]、E/e＇[（7.3±3.2）vs.（8.8±3.1）],以及左室收缩功能指标LVEF[（59.3±4.2）%vs.（56.0±5.4）%]、WMSI[（1.31±0.26）vs.（1.52±0.35）]较pPCI术后24-48h均有改善,差异有统计学意义（P均〈0.05）。脑钠肽（BNP）和C反应蛋白（CRP）水平与E/e＇呈正相关,相关系数（r）分别为0.64（P〈0.01）和0.47（P〈0.05）。结论 急性STEMI患者成功PCI术后左室舒张和收缩功能远期较早期进一步改善。Objective To discuss the long-term changes of left ventricular diastolic function（LVDF） in patients with acute ST-segment elevation myocardial infarction（STEMI） after primary percutaneous coronary intervention（pPCI）. Methods The patients（n=36） with successful pPCI were chosen continuously from Jan. 2014 to Jun. 2014, and finally 33 were included after followed up for 3 m（male 28, female 5, aged from 37 to 83 and average age=61±14）. All of them were given tissue Doppler echocardiogram detection for reviewing left ventricular function 24 h-48 h after pPCI and during 6-m follow-up period. The observation indexes included left ventricular peak early diastolic mitral flow velocity（E）, diastolic mitral annular velocity（e＇）, left ventricular ejection fraction（LVEF） and wall motion score index（WMSI）, and left ventricular filling index（E/e＇） was calculated. ResultsDuring 6-m follow-up period, LVDF grading was improved in 14 cases（42.4%）, deteriorated in 5（15.2%）, and had no changes in 14（42.4%）, and the indexes of e＇ [（10.5±3.6） cm/s vs.（8.6±2.1） cm/s], E/e＇ [（7.3±3.2） vs.（8.8±3.1）], LVEF [（59.3±4.2）% vs.（56.0 ±5.4）%] and WMSI [（1.31±0.26） vs.（1.52±0.35）] were improved compared with those 24 h-48 h after PCI（all P〈0.05）. The level of brain natriuretic peptide（BNP, r=0.64, P〈0.01） and level of C-reactive protein（CRP, r=0.47, P〈0.05） were positively related to E/e＇. Conclusion The left ventricular diastolic and systolic function will be further improved after a longer period than that after a shorter period after successful pPCI in patients with acute STEMI.

关 键 词：超声心动图 组织多普勒 舒张功能 心肌梗死 

分 类 号：R540.45[医药卫生—心血管疾病]