分层应变技术评估急性冠状动脉综合征患者经皮冠状动脉介入治疗术后左室收缩功能  

Evaluation of left ventricular systolic function in patients with acute coronary syndrome after percutaneous coronary intervention by stratified strain technique

作　　者：辛开荣 周青[1] 宋宏宁[1] 雷佳瑞 陈思楷 郑华萍 王士锋 XIN Kairong;ZHOU Qing;SONG Hongning;LEI Jiaru;CHEN Sikai;ZHENG Huaping;WANG Shifeng(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉市430060

出　　处：《临床超声医学杂志》2018年第12期802-806,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨分层应变技术在评估急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后左室收缩功能中的价值。方法选取我院急性起病且首次确诊ACS并接受择期或急诊PCI术治疗的患者44例(ACS组),以及正常体检者40例(对照组)。对对照组及ACS组术前、术后1周、术后3个月、术后6个月行超声心动图分层应变技术检查,分别采集心尖四腔、两腔、三腔心切面及二尖瓣、乳头肌、心尖短轴切面动态图像,连续5个心动周期;应用Echo PAC工作站及分析软件分别获取左室整体及受累节段心内膜下、中层、心外膜下3层心肌收缩期纵向应变(GLSendo、GLSmid、GLSepi、TLSendo、TLSmid、TLSepi)。根据冠状动脉造影结果筛选出受累节段,获取其心内膜下、中层、心外膜下3层心肌的纵向应变,并分析相应参数间的差异。结果与对照组比较,ACS组左室整体及受累节段各层心肌收缩期纵向应变均减低(均P<0.05);与术前比较,ACS组术后左室整体及受累节段各层心肌收缩期纵向应变均有改善,术后1周各应变参数稍增高,但差异无统计学意义;术后3个月、6个月时改善明显(均P<0.05)。结论 PCI术后左室各层心肌收缩功能均有所改善,且心内膜心肌应变的恢复早于心外膜下层心肌。应用分层应变技术获取的应变参数能准确评价ACS患者PCI术前后左室局部和整体收缩功能,能有效评估PCI疗效。Objective To explore the value of stratified strain technique in assessing the left ventricular systolic function changes after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods Forty-four patients(ACS group)with acute onset and initial diagnosis of ACS and received elective or emergency PCI treatment,and 40 cases of normal physical examination(control group)were enrolled.Echocardiography stratified strain technique was performed on the control group and ACS group before operation,1 weeks,3 and 6 months after operation.The apical four-chamber,two-chamber,three-chamber incision and mitral,papillary muscle and apical short-axis dynamic images were collected for five consecutive cardiac cycles.Echo PAC workstation and analysis software were used to obtain the longitudinal strain(GLSendo,GLSmid,GLSepi,TLSendo,TLSmid,TLSepi)of the whole left ventricular and segments in the subendocardial,middle and epicardium.According to the results of coronary angiography,the affected segments were screened and the longitudinal strain of the subendocardial,middle and epicardium were obtained.And the differences of corresponding parameters were analyzed.Results Compared with the control group,the longitudinal strain of whole and affected segments of ACS group were significantly decreased(all P<0.05).The longitudinal strain of the whole left ventricular and affected segments were improved after operation,and the improvement was significant at 3 and 6 months after operation(all P<0.05).The parameters were slightly higher after 1 week operation,but the difference was not statistically significant.Conclusion The myocardial systolic function of the left ventricle is improved after PCI,and the endocardial myocardium strain recovery is faster than subepicardial myocardium.The strain parameters obtained by stratified strain technique can accurately evaluate the local and total systolic function of left ventricle before and after PCI in patients with ACS,which can effectively evaluate the therapeutic

关 键 词：斑点追踪成像 二维 急性冠状动脉综合征 收缩功能 心室 左 冠状动脉介入治疗术 经皮 

分 类 号：R540.45[医药卫生—心血管疾病] R541.4[医药卫生—内科学]