分层应变评价冠状动脉慢性完全性闭塞患者血运重建前后左心室收缩功能早期改变  

Longitudinal layer-specific strain assessment of left ventricular systolic function of patients with coronary chronic total occlusion before and after revascularization

作　　者：左武旭 李权 陈永乐 董丽莉 王翔飞 舒先红 Zuo Wuxu, Li Quan, Chen Yongle, Dong Lili,Wang Xiangfei, Shu Xianhong.(Department of Echocardiography, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, Chin)

机构地区：[1]复旦大学附属中山医院上海市影像医学研究所上海市心血管病研究所心超室,上海200032 [2]复旦大学附属中山医院上海市影像医学研究所上海市心血管病研究所心内科,上海200032

出　　处：《中华超声影像学杂志》2018年第3期185-189,共5页Chinese Journal of Ultrasonography

基　　金：上海市自然科学基金（15ZR1438500）;中山医院青年骨干基金（2017ZSGG11）;国家自然科学基金（81601496）;中山医院优秀青年基金（2017ZSYXQN14）

摘　　要：目的应用二维斑点追踪（2D-STI）技术评价冠状动脉慢性完全性闭塞（CTO）患者经皮冠状动脉介入（PCI）术前1d以及术后1d左心室纵向分层应变，探讨PCI手术对于CTO患者的临床价值。方法选择经冠状动脉造影明确为CTO并成功施行PCI手术的患者3（）例。另外选取29例健康志愿者作为对照组。分别于术前1d及术后1d采集心尖四腔观、两腔观以及心尖部左室长轴超声心动图动态图像，测量左心室舒张末容积（LVEDV）、收缩末容积（LVESV）、射血分数（LVEF）以及每搏输出量（LVSV）。应用组织多普勒（TDI）模式测量左心室二尖瓣环侧壁S波峰值（1ateralS＇）、气室间隔侧s波峰值（septalS’）以及平均S波峰值（averageS’）。应用2D-STI技术分析3个不同切面的纵向分层应变及左心室整体纵向分层应变（GLS）。结果与对照组比较，CTO组术前1d心尖四腔观、两腔观、左室长轴观以及整体的心内膜、中层以及外膜纵向应变均显著降低（P〈0．05），术后1d以上指标均较术前1d明显升高（P〈0．05），但左室长轴观、心尖两腔观及整体的心内膜纵向应变仍低于对照组（均P〈0．05）。CTO组术前1dlateralS’、septalS’以及averageS’较对照组减低（均P〈0．05），术后1d显著增高（均P〈0．05）但与对照组比较差异无统计学意义（均P〉0．05）。其余各参数在三组之间差异无统计学意义（均P〉0．05）。结论CTO患者的左心室纵向收缩功能低于正常人，接受PCI手术之后纵向收缩功能在短期内显著改善。Objective To evaluate the longitudinal layer-specific strain of patients with coronary chronic total occlusion （CTO） before and 1 day after the percutaneous coronary intervention （PCI） by two- dimensional speckle tracking imaging （2D-STI）, and then to explore the clinical value of PCI for patients with CTO. Methods A total of 30 patients diagnosed with CTO through coronary angiograpby and successfully taken the PCI procedure were enrolled in this study. Twenty-nine healthy volunteers were set as the control group. All patients were assigned to take echocardiography 1 day before and 1 day after PCI. The apical four-chamber （4CH）, apical two chamber （2CH） and the apical long-axis （APLAX） echocardiographic images of all subjects were acquired. Left ventricular end-diastolic volume （LVEDV）, end-systolic volume （LVESV）,ejection fraction （LVEF） and stroke volume （LVSV） were measured. The mitral annular lateral S＇, septal S＇ and average S＇ by tissue Doppler imaging （TDI） were also measured. The longitudinal layer-specific strain was analysed by 2D-STI. Results Compared to the control group, CTO group showed a decreased endocardial, midcardial and epicardial longitudinal strain of 4CH, 2CH and APLAX （ P 〈 0.05）. The global endocardial, midcardial and epicardial longitudinal strain were alsodecreased （ P 〈0.05）. On the first day after PCI, these measures were increased compared to those on the first day before PCI （P〈0.05） but the endoeardial longitudinal strain of APLAX, 2CH and GLS were still decreased compared to those of the control group （ P 〈0.05）. The mitral annular lateral S＇, septal S＇ and average S＇ of CTO group were decreased compared to those of the control group （ P〈0.05）. On the first day after PCI, the mitral annular lateral S＇, septal S＇ and average S＇ were increased （ P〈0. 05） but showed no significant difference compared to the control group （ P 〉0.05）. All the other measures showed no significant diff

关 键 词：超声心动描记术 冠状动脉闭塞 斑点追踪显像 心室功能  左 

分 类 号：R540.45[医药卫生—心血管疾病] R543.3[医药卫生—内科学]