斑点追踪成像定量评估老年心肌梗死患者左心室心肌纵向及圆周向应变的研究  

Quantitative assessment of left ventricular longitudinal and circumferential strain in elderly patients with acute myocardial infarction using speckle-tracking imaging on echocardiography

作　　者：邓玉姣 罗渝昆[1] 王一茹[1] 黄鑫[2] 田璠[2] 管博 曹剑[2] 刘涛[3] Deng Yujiao;Luo Yukun;Wang Yiru;Huang Xin;Tian Fan;Guan Bo;Cao Jian;Liu Tao(Department of Ultrasound,The First Medical Center of Chinese PLA General Hospital,Beijing,100853,China;Department of Cardiology,The Second Medical Center of Chinese PLA General Hospital,National Clinical Research Center for Geriatric Diseases,Beijing,100853,China;Department of Ultrasound,The Second Medical Center of Chinese PLA General Hospital,100853)

机构地区：[1]解放军总医院第一医学中心超声科,100853 [2]解放军总医院第二医学中心心内科,国家老年疾病临床医学研究中心,100853 [3]解放军总医院第二医学中心超声科,100853

出　　处：《中华老年医学杂志》2021年第8期991-995,共5页Chinese Journal of Geriatrics

基　　金：解放军总医院军事医学青年扶持项目(QNF19033)。

摘　　要：目的应用斑点追踪成像技术定量评估老年急性心肌梗死(AMI)患者左心室心肌纵向及圆周向应变。方法前瞻性病例对照研究,人选我院2017年8月至2020年6月确诊为ST段拾高型AMI并行冠状动脉造影和经皮冠状动脉介入术(PCI)的老年患者47例(AMI组),分别于术后1周及3个月时行超声检查,另选择同期年龄和性别相匹配的键康志愿者35例为对照组,应用软件分析获取左心室心肌各节段收缩期纵向峰值应变(LPSS)和圆周向峰值应变(CPSS)。结果对照组LPSS、CPSS均星心尖段>中间段>基底段的规律,而AMI组术后1周、术后3个月各节段CPSS、LPSS均降低,失去正常的应变规律。AMI组术后1周左心室整体LPSS.CPSS降低,与对照组比较(-12.3±2.7)%比(-22.5±1.7)%、(-12.9±3.2)%比(-23.1±2.6)%,差异均有统计学意义(t值分别为19.62.15.43,均P<0.01)。AMI组术后3个月时,左心室各节段CPSS、LPSS较AMI术后1周均得到明显改善。AMI組术后3个月整体LPSS、CPSS较术后1周显著增加,(-16.8±2.6)%比(-12.3±2.7)%、(-17.0±3.3)%比(-12.9±3.2)%,差异有统计学意义(值8.23、6.11,均P<0.01),但较对照组仍然减低,(-16.8±2.6)%比(-22.5±1.7)%、(-17.0±3.3)%比(-23.1±2.6)%,差异有统计学意义(t值11.29、9.04,均P<0.01)。结论老年AMI患者左心室心肌各节段纵向应变及圆周向应变均明显受损,斑点追踪成像技术可用于定量评估老年AMI患者PCI术后左心室应变及改善情况。Objective To quantitatively evaluate the left ventricular circumferential and longitudinal strain after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMD using speckle-trackmg imaging(STD on echocardiography.Methods A prospective case-control study was conducted on 47 elderly patients diagnosed with ST-elevation AMI and undergomg percutaneous coronary interference(PCD in our hospital from August 2017 to June 2020 as PCT-study group.The 35 normal subjects matched for age and sex were as a normal-control group.The longitudinal peak systolic strain(LPSS)and circumferential peak systolic strainCCPSS)were measured using STI at one week and three months after PCI in the two groups.Results The values of LPSS and CPSS were apical segment>middle segment>basal segment,which was the similar between LPSS and CPSS.Compared with normal-control group,AMI-PCI group showed that CPSS and LPSS in each segment were"significantly reduced at 1 week and 3 months after operation.Compared with the control group,all the CPSS and LPSS values were significantly decreased in AMI group at one week after PCIC-12.3±2.7)%vs.(-22.5±1.7)%(t=19.62,P<0.01);(12.9±3.2)%vs.(-23.1±2.6)%(t=15.43,P<0.01).Both LPSS and CPSS values were improved at a certain extent at three months after PCI compared with AMI group at one week after PCI.The complete CPSS and LPSS values were significantly increased in AMI group at three months after PCI compared with one week after PCIC-16.8±2.6)%vs.(-12.3±2.7)%,(t=8.23,P<0.01);(17.0±3.3)%vs.(-12.9±3.2)%(t=6.11,P<0.01).But,there were still significant differences compared with the NC group(-16.8±2.6)%vs.(-22.5±1.7)%(t=11.29,P<0.01);(-17.0±3.3)%vs.(-23.1±2.6)%(t=9.04,P<0.01).Conclusions The longitudinal and circumferential strain of left ventricle were severely damaged in elderly patients with AMI.The speckle-tracking imaging technique can be used to quantitatively evaluate the left ventricular strain and its improved situation after PCI in elderly AMI patients.

关 键 词：心肌梗死 心室功能 左 超声心动描记术 

分 类 号：R542.22[医药卫生—心血管疾病] R445.1[医药卫生—内科学]