心肌声学造影评价冠状动脉慢性完全闭塞病变患者介入治疗的早期疗效  

Evaluation of early efficacy of percutaneous coronary intervention in patients with coronary chronic total occlusion by myocardial contrast echocardiography

作　　者：黄艳 丁明岩 栾波 冀威 李颖[1] 张慧慧[1] 朱芳[1] HUANG Yan;DING Mingyan;LUAN Bo;JI Wei;LI Ying;ZHANG Huihui;ZHU Fang(Department of Cardiac Function,the People’s Hospital of China Medical University,Shenyang 110016,China)

机构地区：[1]中国医科大学人民医院心功能科,沈阳市110016

出　　处：《临床超声医学杂志》2020年第5期326-330,共5页Journal of Clinical Ultrasound in Medicine

基　　金：辽宁省自然科学基金项目(20170540542)。

摘　　要：目的探讨心肌声学造影和二维斑点追踪成像技术在评价冠状动脉慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)后左室功能早期恢复中的应用价值。方法选取拟行PCI血运重建的CTO病变患者39例作为病例组,另选年龄、性别与其相匹配且冠状动脉造影正常者39例作为对照组,术前分别行常规超声心动图、二维斑点追踪成像和心肌声学造影检查,病例组于PCI血运重建术后72 h内再行超声检查,比较手术前后左室功能参数,并按所开通冠状动脉不同将病例组分为3个亚组:左前降支组16例、左回旋支组4例和右冠状动脉组19例,比较各亚组冠状动脉对应供血区域手术前后局部心肌灌注和局部心肌纵向应变(RLS)的差异。结果PCI术前病例组与对照组比较,灌注计分指数(PSI)较高,左室整体纵向应变(GLS)、曲线平台期峰值强度(A)、曲线斜率(β)、心肌血流量(A·β)均较低,差异均有统计学意义(均P<0.05)。PCI术后病例组常规左室功能参数与术前比较,差异均无统计学意义;PSI较术前显著降低,GLS、A、β、A·β均较术前显著增加,差异均有统计学意义(均P<0.05)。左前降支组、右冠状动脉组、左回旋支组中CTO患者开通冠状动脉对应供血区域心肌的RLS、PSI、A、β、A·β与术前比较,差异均有统计学意义(均P<0.05)。结论心肌声学造影和二维斑点追踪成像均可以早期、定量地评价PCI血运重建术后CTO患者的左室整体、局部心肌灌注和运动功能改善情况。Objective To investigate the value of myocardial contrast echocardiography and two-dimensional speckle tracking imaging in the evaluation of early left ventricular recovery after percutaneous coronary intervention(PCI)in patients with coronary chronic total occlusion(CTO).Methods A total of 39 patients with CTO lesions planned for PCI revascularization were enrolled as the experimental group,and 39 subjects with normal coronary angiography and age and sex matched as control group,conventional two-dimensional echocardiography,two-dimensional speckle tracking imaging and myocardial contrast echocardiography were performed before operation,experimental group underwent ultrasonography within 72 h post-PCI revascularization,the left and right ventricular function parameters before and after the operation were compared.According to the different coronary vessels opened,the experimental group were divided into three subgroups:the left anterior descending branch group(16 cases),the left circumflex branch group(4 cases)and the right coronary artery group(19 cases).The regional myocardial perfusion and regional myocardial longitudinal strain(RLS)before and after surgery were compared.Results The global longitudinal strain(GLS),the peak signal intensity of the plateau phase(A),the slope of curve in each myocardial segment(β),and the regional myocardial blood flow per second(A·β)in CTO group were lower than those of control group while the myocardial perfusion score index(PSI)was higher before PCI,and the differences were statistically significant(all P<0.05).In the experimental group,there were no statistically significant differences in the traditional left ventricular function parameters compared with those before PCI.The post-PCI PSI was significantly lower than that of pre-PCI,the GLS,A,β,A·βwere significantly increased compared with pre-PCI,the differences were statistically significant(all P<0.05).Among the three subgroups of CTO patients,the RLS,PSI,A,β,A·βof each coronary artery donated area were significan

关 键 词：斑点追踪成像 二维 心肌声学造影 冠状动脉慢性完全闭塞 冠状动脉介入 经皮 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病]