两种不同介入策略对急性非ST段抬高型心肌梗死合并多支血管病变患者左心室扭转的影响  

Comparation of two different strategy intervention on impact of left ventricular rotation and torsion in patients with non-ST-segment elevation myocardial infarction complicated with multivessel disease

作　　者：徐茂椿[1] 沈燕[2] 陆纪德[1] 王璐[1] 贾照英 袁晓菲 刘淼[2] XU Mao-chun;SHEN Yan;LU Ji-de;WANG Lu;JIA Zhao-ying;YUAN Xiao-fei;LIU Miao(Department of Cardiology,Pudong New area Gongli Hospital,Shanghai 200135,China;Department of Cardiac Echocardiography,Pudong New area Gongli Hospital,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院心内科,上海200135 [2]上海市浦东新区公利医院心脏超声科,上海200135

出　　处：《岭南心血管病杂志》2021年第5期532-537,共6页South China Journal of Cardiovascular Diseases

基　　金：上海浦东新区卫计委科研项目(项目编号:PW2017A-19)。

摘　　要：目的采用二维斑点追踪成像技术比较早期完全或部分血运重建策略治疗急性非ST段抬高型心肌梗死患者术后左心室扭转运动的改变情况。方法将2017年11月至2019年11月上海市浦东新区公利医院103例发病12 h内的急性非ST段抬高型心肌梗死合并多支血管病变的患者随机分为完全血运重建组(CR组)和部分血运重建组(IR组)。所有患者均于术前和术后1周、3个月及1年采用二维斑点追踪成像技术分析左心室心尖部及基底部的收缩期扭转数据。结果(1)术前两组患者左心室心尖及基底段旋转角度峰值及净扭转峰值比较,差异无统计学意义(P>0.05)。(2)术后1周,完全血运重建组患者基底段旋转角度峰值较术前有增加,但差异无统计学意义(P>0.05)。术后3个月,两组患者心尖段旋转角度峰值均较术前明显增加,差异有统计学意义(均P<0.01);而仅在完全血运重建组患者基底段旋转角度峰值较术前增加,差异有统计学意义(P<0.01)。术后1年,完全血运重建组患者各个节段旋转角度峰值与部分血运重建组患者比较,均明显改善,差异均有统计学意义(P<0.01);其中,整体净扭转峰值有改善显著,差异有统计学意义(8.9°±4.5°vs.16.3°±5.1°,P<0.01)。结论对于急性非ST段抬高型心肌梗死患者,早期完全血运重建能够更好地改善左心室收缩期扭转运动。Objectives To compare the changes of left ventricular(LV)torsion in patients with non-ST-segment elevation myocardial infarction(NSTEMI)and multivessel coronary artery disease(MVD)treated by complete revascularization(CR)or incomplete coronary revascularization(IR)through two dimensional speckle tracking imaging technology.Methods Totally 103 patients with NSTEMI complicated with MVD within 12 hours after onset between November 2017 and November 2019 in Gongli Hospital were randomly assigned in a 1∶1 manner to CR-percutaneous coronary intervention(PCI)or IR-PCI.Two-dimensional echocardiography was performed for the assessment of LV volumes and function and two-dimensional speckle tracking echocardiography was performed for the assessment of LV rotational mechanics in all subjects before operation and 1 weeks,3 months,1 year after operation.Results With regard to echocardiographic data,baseline qualitative ventricular function was not statistically different between the two groups(P>0.05).One week after operation,the peak rotation angle of the basal segment in CR group was higher than that before operation,but the difference was not statistically significant(P>0.05).Three months after operation,the peak rotation angles of apical segment in both groups were significantly higher than those before operation,while the peak rotation angle of basal segment only in CR group was significantly higher than that before operation(P<0.01).One year after operation,compared with IR group,the peak rotation angle of each segment in CR group was significantly different(P<0.01),obviously in overall net torsional peak(8.9°±4.5°vs.16.3°±5.1°,P<0.01).Conclusions Early CR can improve LV systolic torsion in patients with acute NSTEMI.

关 键 词：心肌梗死 多支血管病变 左心室扭转 斑点追踪成像 

分 类 号：R542.22[医药卫生—心血管疾病]