二维斑点追踪分层应变技术评估AMI伴心功能不全患者存活心肌  

Layer-specific two-dimensional speckle strain tracking technique for evaluation of viable myocardium in AMI patients with cardiac insufficiency

作　　者：刘琨 李公豪[2] 王燕 陈鹏[4] 李东野[1] LIU Kun;LI Gong-hao;WANG Yan;CHEN Peng;LI Dong-ye(Cardiovascular Disease Institute,Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学心血管病研究所,江苏徐州221002 [2]连云港市第一人民医院心内科,江苏连云港222002 [3]连云港市第一人民医院心脏超声室,江苏连云港222002 [4]连云港市第一人民医院核医学科,江苏连云港222002

出　　处：《中国临床研究》2018年第11期1475-1479,共5页Chinese Journal of Clinical Research

摘　　要：目的探讨应用二维斑点追踪心脏彩超(2D-STE)分层纵向应变(LS)及应变率(LSr)评估急性心肌梗死(AMI)伴心功能不全患者存活心肌的价值。方法 2016年2月至2017年5月30例经胸心脏超声检查存在左室收缩功能障碍[左室射血分数(LVEF)<45%]的AMI患者,在择期行经皮冠状动脉介入治疗(PCI)术前行分层二维斑点追踪心脏彩超(LS2D-STE)检查,测定左室各层(内膜、中膜、外膜)的17节段的纵向收缩期达峰应变(LS)及纵向收缩期达峰应变率(LSr),PCI术后1、3、6个月复查心脏彩超,室壁运动改善作为评定存活心肌的金标准。结果 PCI术后LVEF较PCI术前显著改善[(48. 65±3. 19)%vs (40. 45±4. 16)%,P <0. 05]。存活心肌节段及非存活心肌节段内膜、中膜、外膜的LS与LSr比较均有统计学差异(P <0. 05,P <0. 01)。ROC曲线分析提示内膜、中膜、外膜的LS、LSr对预测存活心肌有一定价值(AUC> 0. 5,P <0. 05)。多因素Logistic回归分析显示只有内膜LS、LSr作为独立的预测存活心肌的参数。内膜LS、LSr最佳截断点为-11. 20,-0. 85,其诊断存活心肌敏感度、特异度、准确度分别为78. 9%、65. 6%、72. 1%;73. 4%、67. 2%、70. 5%。结论 LVEF在PCI术后较术前可见明显改善,LS2D-STE尤其是内膜LS、LSr可较好地早期评估AMI伴心功能不全患者存活心肌。Objective To investigate the value of longitudinal strain（LS） and longitudinal strain rate（LSr） measured by layer-specific two-dimensional speckle tracking echocardiography（LS2 D-STE） for evaluating viable myocardium in acute myocardial infarction（AMI） patients with cardiacinsufficiency. Methods Thirty AMI patients with left ventricular systolic dysfunction [left ventricular ejection fraction（LVEF） 45%] confirmed by transthoracic echocardiography examination were selected. The patients received LS2 D-STE examination before scheduled percutaneous coronary intervention（PCI） to measure 17-segmen systolic peak LSand systolic peak LSr of each layer（intima,media,adventitia） of left ventricle.Echocardiography was re-examined at 1-,3-and 6-month after PCI,and the improvement of ventricular wall motion was served as the gold criteria for evaluating viable myocardium. Results LVEF was improved significantly after PCI in all patients compared with pre-operation [（48. 65 ± 3. 19） % vs（40. 45 ± 4. 16） %,P〈0. 05]. There were significant differences in LS and LSr at intima,media and adventitia between viable myocardial segments and non-viable myocardial segments（P〈0. 05,P〈0. 01）. ROC curve analysis showed that LS and LSr of intima,media and adventitia had certain values for predicting viable myocardium（AUC〉0. 5,P〈0. 05）. Logistic multivariate regression showed that LS and LSr of intima may be only served as the independent parameters predicting viable myocardium. Taking-11. 20（LS） and-0. 85（LSr） as the best cut-off points,the sensitivity,specificity and accuracy predicting surviving myocardium were 78. 9%,65. 6%,72. 1% for intima LSand 73. 4%,67. 2%,70. 5% for intima LSr. Conclusions LVEF after PCI was improved significantly compared with before PCI. LS2 D-STE,especially LS and LSr of intima,canevaluate viable myocardium early and better in patients with AMI with cardiac insufficiency.

关 键 词：心肌梗死 急性 心功能不全 分层二维斑点追踪心脏彩超 存活心肌 纵向收缩期达峰应变 纵向收缩期达峰应变率 

分 类 号：R542.22[医药卫生—心血管疾病] R541.61[医药卫生—内科学]