室壁分层分析技术评价ST段抬高心肌梗死患者的心肌运动  

Layer-specific Analysis in Patients with ST Segment Elevation Myocardial Infarction

作　　者：黄鹤[1] 刘晓琴[1] 黄宝涛[1] 姚鸿梅[2] 张晓玲[1] 

机构地区：[1]四川大学华西医院心内科,成都610041 [2]成都市第五人民医院心内科,成都611130

出　　处：《四川大学学报（医学版）》2016年第5期743-748,共6页Journal of Sichuan University(Medical Sciences)

摘　　要：目的 运用室壁分层分析技术评价ST段抬高心肌梗死（STEMI）患者左室壁三层心肌运动情况及其预测左室重塑的能力。方法 纳入成功行直接冠脉介入（P-PCI）的初次STEMI患者39例及30例正常对照。在P-PCI术后48h内（随访前）及6个月时（随访时）行超声心动图检查。分析三维心功能及室壁长轴及圆周内、中、外三层应变。结果 1 STEMI患者随访前室壁长轴内层应变高于外层（P〈0.01）,圆周分层应变由内向外减小（P〈0.01）。左室壁长轴及圆周三层应变随访时均较随访前增高（P〈0.01）,但仍低于正常对照组（P〈0.05）。2左室重塑组随访前、随访时左室壁分层应变低于非重塑组（P〈0.05）,两组随访时分层应变均较随访前增高（P〈0.05）。3长轴外层应变是左室重塑的独立预测因素（比值比：3.332,95%可信区间：1.124~3.882,P=0.03）,其预测左室重塑切点值为-9%（敏感度89.5%,特异度70.2%）。结论 P-PCI术后48h内STEMI患者室壁应变从内层向外层减低,左室重塑组心肌功能低于非重塑组,左室壁长轴外层应变可独立预测STEMI患者的左室重塑。Objective To evaluate left ventricular wall function after ST segment elevation myocardial infarction（STEMI） by layer-specific analysis and determine if the layer-specific parameters can predict left ventrieular remodeling （LVR）. Methods Thirty nine patients with first STEMI who had successful primary percutaneous coronary intervention（P-PCI） were studied, while 30 healthy individuals were included as normal control. Echocardiographic examinations were performed in STEMI patients within 48 h after P-PCI （before follow- up） and 6 months later （follow-up）. Three dimensional cardiac function and longitudinal, circumferential 3-layer strain were analyzed. Results In STEMI, longitudinal endocardial strain was higher than epieardial strain （P〈0.01）, circumferential strain decreased from endocardium to epicardium gradually （P〈0.01）. Longitudinal and circumferential 3-layer strain at follow-up was higher than that before follow-up （P〈0.01）, but lower than that in control group （P 〈 0. 05）. LVR group had lower longitudinal and circumferential 3-layer strain （P〈0. 05）. Longitudinal epicardial strain was the independent predictor of LVR （odds ratio： 3. 332,95% confidence interval： 1. 124-3. 882,P=0.03）, the cut off value of - 9 % yielded 89.5 % sensitivity and 70.2% specificity. Conclusion Strain decreased from endocardium to epicardium within 48 h after P-PCI in STEMI. Myocardial function was lower in LVR group. Longitudinal epieardial strain could be employed as an independent predictor of LVR after STEMI.

关 键 词：室壁分层分析 心肌梗死 左室重塑 

分 类 号：R542.22[医药卫生—心血管疾病]