经皮冠状动脉介入治疗与左心室舒张功能减退的相关性研究  

Impact of Percutaneous Coronary Intervention on Left Ventricular Diastolic Dysfunction in Patients With Coronary Artery Diseases

作　　者：徐燕南 胡文娟 王昌华[3] 张红[2] 张琼 马江伟[4] XU Yannan;HU Wenjuan;WANG Changhua;ZHANG Hong;ZHANG Qiong;MA Jiangwei(Medical College,Anhui University of Science and Technology,Huainan(232000),Anhui,China)

机构地区：[1]安徽理工大学医学院,安徽省淮南市232000 [2]山东省滕州市中心人民医院影像中心 [3]山东省滕州市中心人民医院放射科 [4]上海交通大学附属第六人民医院南院心内科

出　　处：《中国循环杂志》2021年第6期546-552,共7页Chinese Circulation Journal

基　　金：上海市科学技术委员会面上项目(17411969400)。

摘　　要：目的:探究经皮冠状动脉介入治疗(PCI)对冠心病患者左心室舒张功能的影响及相关危险因素分析。方法:本研究共纳入2017年10月至2019年10月首次行PCI,且术后1年来院复查冠状动脉造影的不稳定性心绞痛患者302例。根据支架置入数目分Ⅰ组:1枚支架(123例),Ⅱ组:2枚支架(108例),Ⅲ组:≥3枚支架(71例)。所有患者术前、术后1年复查均行超声心动图及左心室造影检查,测定左心室舒张功能、冠状动脉压力及容积。对比各组患者左心室舒张功能。结果:(1)与PCI术前比,术后1年复查患者E峰减速时间(DT)、左心房前后径(LAD)、二尖瓣舒张早期血流峰值与二尖瓣环运动速度之比(E/e'值)、左心室等容舒张松弛时间常数(Tau)、B型利钠肽、甘油三酯水平及舒张功能异常的患者比例均升高(P均<0.05)。(2)与Ⅰ组比较,Ⅱ组和Ⅲ组DT、LAD、E/e'值及三支冠状动脉病变患者比例均较高;与Ⅱ组比较,Ⅲ组DT、E/e'值及三支冠状动脉病变患者比例均较高(P均<0.05),进一步对各组患者术前、术后1年基本临床资料比较:Ⅲ组患者DT、LAD、E/e'值、Tau、舒张功能异常患者比例显著高于术前(P均<0.05)。(3)与Ⅰ组比,Ⅱ组和Ⅲ组左心室舒张末期容积(LVEDV)、Tau均较高(P均<0.05),Ⅱ组和Ⅲ组左心室压力下降最大速度(LV-dp/dtmax)、冠状动脉压力上升最大速度(C+dp/dtmax)、冠状动脉压力下降最大速度(C-dp/dtmax)、冠状动脉舒张末期容积(CEDV)、冠状动脉收缩末期容积(CESV)均较低(P均<0.05);与Ⅱ组比较,Ⅲ组Tau较高,CEDV、CESV、C+dp/dtmax、C-dp/dtmax均较低(P均<0.05)。(4)Spearman相关分析显示:支架数目、Gensini评分、年龄、E/e'值与Tau呈正相关,体表面积、甘油三酯、血肌酐与Tau呈负相关,调整变量后,偏相关分析显示支架数目与Tau呈正相关(r=0.188,P<0.05)。结论:冠心病患者PCI术后左心室舒张功能并未得到有效改善,多支架置入可能与左心室舒张Objectives:To explore the impact of percutaneous coronary intervention on left ventricular diastolic function in patients with coronary artery disease and analysis of related risk factors of left ventricular diastolic dysfunction in these patients.Methods:A total of 302 patients who underwent first PCI and underwent repeat coronary angiography within 1 year after PCI from October 2017 to October 2019 were included.According to the number of implanted stents,patients were divided into groupⅠ(n=123),groupⅡ(n=108),and groupⅢ(n=71),respectively.Echocardiography and left ventricular angiography were performed in all patients before and after operation.Left ventricular diastolic function,coronary volume and pressure were compared among groups.Results:(1)DT,LAD,E/e'value,Tau,percent of diastolic dysfunction,triglyceride,BNP were all significantly higher after PCI than those before PCI(all P<0.05).(2)DT,LAD,E/e'value were higher in groupⅡand groupⅢthan in groupⅠ(all P<0.05).DT and E/e'values were significantly higher in groupⅢthan in group II(both P<0.05).Preoperative and postoperative clinical data comparison showed that DT,LAD,E/e'value,Tau and percent of diastolic dysfunction were significantly higher at one year post PCI than pre-PCI values in groupⅢ.(3)At one year after PCI,the Tau,LVEDV values were higher in groupⅡand groupⅢthan in GroupⅠ(P<0.05),while LV-dp/dtmax,CEDV,CESV,C+dp/dtmax,C-dp/dtmax values were all lower in groupⅡand groupⅢthan in Group I(P<0.05).Compared with groupⅡ,the Tau value was higher and CEDV,CESV,C+dp/dtmax,C-dp/dtmax values were lower in groupⅢ(P<0.05).(4)Spearman correlation analysis showed the number of stents,Gensini score,age,E/e’value were positively correlated with Tau(P<0.05);BSA,triglyceride and creatinine values were negatively correlated with Tau(P<0.05).After adjusting the cofounders,partial correlation analysis showed that the number of stents was positively correlated with Tau(r=0.188,P<0.05).Conclusions:Progressive left ventricular diastolic dysfu

关 键 词：冠心病 血运重建 冠状动脉支架 左心室舒张功能 

分 类 号：R54[医药卫生—心血管疾病]