心腔声学造影评估ST段抬高型心肌梗死患者左心室重构参数的应用价值  

The value of left ventricular opacification for measuring left ventricular remodeling parameters in ST-elevation myocardial infarction patients

作　　者：周燕翔 熊叶 雷佳瑞 曹清琼 曹省[1] 陈金玲[1] 周青[1] Zhou Yanxiang;Xiong Ye;Lei Jiarui;Cao Qingqiong;Cao Sheng;Chen Jinling;Zhou Qing(Department of Ultrasonography,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,430060

出　　处：《中华超声影像学杂志》2021年第8期661-667,共7页Chinese Journal of Ultrasonography

基　　金：中央高校基本科研业务费专项资金资助(2042021kf0121)。

摘　　要：目的探讨心腔声学造影评价ST段抬高型心肌梗死(STEMI)患者左室重构参数的应用价值。方法纳入2018年4月至2019年12月于武汉大学人民医院就诊的69例STEMI患者并采集非造影及造影模式心尖四腔、三腔、两腔切面连续动态图像。按非造影模式心内膜显示情况将患者分为图像质量佳组(23例)及图像质量不佳组(46例)。比较两组间非造影及造影模式心内膜节段显示率、附壁血栓诊断率,并评价图像质量不佳组造影模式左室整体图像质量及左室心尖部显示的改善情况。测量非造影及造影模式左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、左室整体纵向应变(GLS),并比较两组间不同模式测量参数的差异及可重复性,评估造影模式测量GLS的可行性及准确性。结果①不论非造影模式图像质量如何,造影模式心内膜节段显示率高于非造影模式(均P<0.05)。②对于图像质量不佳组,造影模式左室整体图像质量及左室心尖部显示情况得到明显改善(均P<0.05)。③对于图像质量不佳组,造影模式LVESV测值高于非造影模式,LVEF及GLS低于非造影模式(均P<0.05)。④图像质量佳组造影及非造影模式测量GLS的相关性为0.912,两种模式测值大部分均在一致性界值内;对于图像质量不佳组,与非造影模式相比,造影模式GLS与LVEF的相关性更高(0.731对0.709)。⑤对于图像质量佳者,造影模式大部分参数的组内相关系数稍增加,尤其对于观察者间;对于图像质量不佳者,造影模式测量左室重构参数的观察者内及观察者间组内相关系数均较非造影模式显著增加。结论心腔声学造影可以更清晰地显示STEMI患者左室细微解剖结构并获取重复性更好的左室重构参数如LVEDV、LVESV、LVEF、GLS,尤其对于图像质量不佳者。Objective To investigate the value of left ventricular opacification(LVO)for measuring left ventricular(LV)remodeling parameters in ST-elevation myocardial infarction(STEMI)patients.Methods Sixty-nine STEMI patients in Renmin Hospital of Wuhan University from April 2018 to December 2019 were enrolled.The apical four-chamber,three-chamber and two-chamber views of LV were collected with unenhanced and contrast-enhanced modes.According to the endocardium display in the unenhanced mode,all patients were divided into two groups:excellent image quality group(n=23)and poor image quality group(n=46).The endocardial segment display rate and mural thrombus diagnosis rate were compared between the two groups,and the improvement of LV overall image quality and LV apex display were evaluated in the poor image quality group.LV end diastolic volume(LVEDV),LV end systolic volume(LVESV),LV ejection fraction(LVEF)and LV global longitudinal strain(GLS)were measured with unenhanced and contrast-enhanced modes,respectively.The differences and repeatability of LV remodeling measurements of LVEDV,LVESV,LVEF and GLS in each group were compared with unenhanced and contrast-enhanced modes,and the feasibility and accuracy of GLS in contrast-enhanced mode were evaluated.Results①Regardless of the image quality in the unenhanced mode,the display rate of endocardial segment in the contrast-enhanced mode was higher than that in the unenhanced mode(all P<0.05).②For the poor image quality group,the overall image quality of LV and the display of LV apex were significantly improved in the contrast-enhanced mode(all P<0.05).③For the poor image quality group,LVESV in contrast-enhanced mode was higher,while LVEF and GLS were lower than those in the unenhanced mode(all P<0.05).④The correlation between GLS measured in contrast-enhanced and unenhanced mode was 0.912,and most of the measurements in the two modes were within the consistency threshold.For the poor image quality group,compared with GLS measured in the unenhanced mode,the correlation

关 键 词：超声心动描记术 心肌梗死 心室功能 左 超声造影剂 

分 类 号：R542.22[医药卫生—心血管疾病]