急性心肌梗死患者冠状动脉介入治疗术后心功能中远期变化的二维斑点追踪显像研究  

Study on the mid- and long-term changes of ventricular torsion and cardiac function after PCI in Acute myocardial infarction patients by two-dimensional speckle tracking imaging

作　　者：张爱红[1] 景江新[1] 王霞[1] 宋鹏远[1] 李君[1] 吴山[2] 王红[3] 

机构地区：[1]新疆医科大学第二附属医院超声科,乌鲁木齐830063 [2]首都医科大学附属北京安贞医院超声心动图一部,北京100029 [3]新疆医科大学第二附属医院影像中心,乌鲁木齐830063

出　　处：《新疆医科大学学报》2016年第2期230-234,238,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2012211A032)

摘　　要：目的应用二维超声斑点追踪技术观察急性心肌梗死患者冠状动脉介入治疗(PCI)术后中远期心功能变化特点及其相关性。方法选择急性心肌梗死后24 h内行PCI术患者200例,于术前及术后1 w测量左室扭转角度与左室射血分数,根据术后1 w左室扭转角度与术前扭转角度的变化分为有改善组(136例)、无改善组(48例)、减低组(16例)。以100例正常健康体检者作为对照组,使用二维超声斑点追踪技术分别于术后1、3、6、12个月测量心尖水平与瓣环水平左室短轴心肌旋转角度及左室扭转角度,同时使用超声心动图测量心室腔大小、LVEF等常规超声指标。结果 (1)PCI术后1、3、6、12个月各组LVEDD、LVESD、LVEDV、LVESV比较差异无统计学意义(P>0.05),与术后1 w比较,术后1、3、6、12个月有改善组LVEF明显增高,减低组LVEF进一步降低,差异有统计学意义(P<0.05),无改善组LVEF略增加,但差异无统计学意义(P>0.05)。(2)与术后1 w比较,术后1、3、6、12个月有改善组左室扭转角度明显增加,减低组扭转角度进一步降低,差异有统计学意义(P<0.05),无改善组12个月心尖部旋转角度与左室扭转角度增加,差异有统计学意义(P<0.05)。(3)术后1 w各组左室扭转角度与LVEF均有较好的相关性(r分别为0.730、0.708、0.755,P<0.05)。ROC曲线显示以左室整体扭转角度15.0°为临界值,预测LVEF<45%的曲线下面积、灵敏性、特异性分别为0.963、95%、84%。结论急性心肌梗死后及时行PCI术可以有效改善患者的中、远期心功能,心肌扭转角度可反映PCI术后心功能变化,亦可作为预测PCI术远期疗效的重要参数。Objective To study on the mid-and long-term changes of left ventricular torsion and cardiac function after percutaneous coronary intervention（ PCI） in acute myocardial infarction patients by two-dimensional speckle tracking imaging（ 2D-STI）. Methods 200 patients with acute myocardial infarction after PCI were collected,the2D-STI was used to measure the left ventricular torsion angles and LVEF at preoperative and postoperative 1 week,then according to the left ventricular torsion angles change at postoperative 1 week,divided the patients into improved group（ 136 cases）,not improved group（ 48 cases） and reduced group（ 16 cases）,and 100 cases of healthy patients as a control group. 2D-STI technology was performed to measure left ventricular rotation angles at apex and valve level of LV short axis view at postoperative 1 month,3 month,6 months and 12 months,and the common parameters were measured by echocardiography. Results（ 1） There was no statistically significant difference in LVEDD,LVESD,LVEDV,LVESV at postoperative 1 week,1 month,3 months,6 months and 12 months in the every group（ P〈0. 05）,compared with the postoperative 1 week,there were an increase in LVEF at postoperative 1 month,3month,6 month and 12 month in the improve group,while LVEF in reduced group were further lower,the differences were statistically significant（ P〈0. 05）. The LVEFs of no improve group were slightly increased,but there was no statistically significant difference（ P〉0. 05）.（ 2） Compared with the postoperative1 week,the left ventricular torsion angles at postoperative 1 month,3 months,6 months and 12 months in improve group were obviously increased. While in reduce group,there were further decreased in the left ventricular torsion angles,and the differences were statistically significant（ P〈0. 05）. However,the apex rotation angles and left ventricular torsion angles of not improved group at postoperative 12 months were increased,and the differences were statistically significant（ P�

关 键 词：急性心肌梗死 冠脉介入治疗术 左室扭转 心功能 

分 类 号：R540.45[医药卫生—心血管疾病]