二维斑点追踪显像、实时三维超声心动图评价急性心肌梗死早期左心室机械不同步动态演变及与核素心肌显像的比较  

Temporal changes of left ventricular mechanical dyssynchrony early after acute myocardial infarction assessed by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography： a comparison with single photo emission computed tomography gated myocardial perfusion imaging measurement

作　　者：张飞飞 徐敏[1] 王跃涛[1] 刘飞[1] 王建锋[1] 邵晓梁[1] 田毅 范圣登[2] 陈勇峻 牛荣[1] 徐梅[1] 陆培奇 

机构地区：[1]苏州大学附属第三医院常州市第一人民医院核医学科,常州213003 [2]苏州大学附属第三医院常州市第一人民医院麻醉科,常州213003 [3]苏州大学附属第三医院常州市第一人民医院心内科,常州213003 [4]首都医科大学附属北京安贞医院核医学科

出　　处：《中华超声影像学杂志》2018年第2期164-169,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目（81471690）;江苏省科技计划一重点病种规范化诊疗项目（BE2015635）;常州市卫生局重点项目（ZD20409）

摘　　要：目的应用二维斑点追踪显像（2D-STI）、实时三维超声心动图（RT3DE）评价急性心肌梗死（AMI）早期左心室机械不同步的动态变化，比较2D-STI、RT-3DE与门控心肌灌注单光子发射计算机断层成像（SPEcTGMPI）技术的相关性，探讨AMI后早期左心室机械不同步动态演变的临床意义。方法选取巴马小型猪11只，用球囊选择性封堵左前降支制备AMI模型，分别于建模前和AMI后1d、1周、4周行2D-STI、RT3DE等检查，于建模前和AMI后1d行SPECTGMPI检查。分析AMI前后左心室机械同步性的动态变化规律，比较两种超声技术与SPECTGMPI测得AMI后左心室机械不同步的相关性。结果8只猪建模成功并完成研究。与建模前相比，AMI后1d2D—STI、RT-3DE和SPECTGMPI左心室机械同步性指标左心室整体纵向应变值（GLS）、左心室纵向应变达峰时间的标准差（TimeSD）、左心室16节段达最小容积时间的标准差的标化值（Tmsvl6-SD％）、左心室16节段达最小容积时间的最大差值的标化值（Tmsv16-Dif％）、直方图带宽（BW）、相位标准差（SD）及熵均明显增大，出现左心室机械不同步（均P〈0．05）。AMI后1周较1d时GLS、TimeSD、Tmsv16-SD％及Tmsv16-Dif％无显著改变，AMI后4周较1d上述指标进一步增大（均P〈0．05）。建模前和AMI后1d21〉STI参数GLS与SPECTGMPI参数BW呈正相关（r=0．708～0．719，P〈0．05），TimeSD与SPECTGMPI参数sD呈正相关（r=0．717～0．830，P〈0．05）；RT-3DE参数Tmsv]6-Dif％与BW相关性良好（r=0．713～0．857，P〈0．05）；Tmsv16-SD％与SD相关性良好（r=0．㈧3～0．957，P〈0．05）。结论AMI后1d即发生左心室机械不同步，1周时无显著改变，至4周时左心室机械不同步进一步加重。2D-STI、RT～3DE与GMPI所测左心室机械同步性参数均具有良好的相关性，2D-STI及RT3DE技术可作为评价AMI后左心室机械不同步的可靠方法。Objective To evaluate the dynamic changes of left ventricular mechanical synchrony in the early period after acute myocardial infarction （AMI） by two-dimensional speckle tracking imaging （2D- STI） and real-time three-dimensional eehocardiography （RT-3DE）, and analyze the correlation with phase analysis of single photo emission computed tomography gated myocardial perfusion imaging （SPECT GMPI） in porcine models, and further to investigate the clinical significance of left ventricular mechanical dyssynchrony in patients with AMI. Methods Bama minipigs（ n = 11） were subjected to left anterior descending（LAD） occlusion by balloon to introduce AMI porcine models. All animals underwent 2D-STI and RT-3DE at the baseline （before AMI）, 1 day, 1 week and 4 weeks after LAD occlusion, respectively. In addition, SPECT GMPI was measured at baseline and 1 day after AMI. Data was analyzed and compared the dynamic changes of left ventricular mechanical synchrony before and after AMI. Then the correlation between eehocardiography and SPECT GMPI in evaluating left ventricular mechanical synchrony before and after AMI were calculated. Results Eight pigs were successfully established as AMI models and complete the study. SPECT GMPI, 2D-STI and RT-3DE showed that the left ventricular mechanical synchrony indexes were significantly higher at 1 day after AMI than those before AMI, which means the appearance of left ventricular mechanical dyssynchrony. Compared with those 1 day after AMI, GLS, Time SD, Tmsv16- SD% and Tmsv16-Dif% did not change significantly at 1 week after AMI, but they significantly increased at 4 weeks after AMI （all P G0.05）. At baseline and 1 day after AMI,the GLS measured by 2D-STI and the SPECT GMPI parameter phase bandwidth （BW） showed good correlation（ r = 0. 708- 0. 719, P 〈0.05）, Time SD was significantly correlated with the SPECT GMPI parameter phase standard deviation （SD）（ r = 0. 717 - 0. 830, P G0.05）, while Tmsv16-Dif% derived from RT-3DE had a better pos

关 键 词：斑点追踪显像 超声心动描记术 实时三维 心肌梗死 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病] R542.22[医药卫生—内科学]