急性心肌梗死患者介入术后早期超声心肌灌注评分与心功能的相关性  

Correlation Between Early Ultrasonic Myocardial Perfusion Score and Cardiac Function in Patients with Acute Myocardial Infarction After Intervention

作　　者：靳文英[1] 朱天刚[1] 王岚[1] 马玉良[1] 于超[1] 张锋[1] 宋媛媛 Jin Wenying;Zhu Tiangang;Wang Lan;Ma Yuliang;Yu Chao;Zhang Feng;Song Yuanyuan(Department of Cardiology,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction,Center for Cardiovascular Translational Research,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心血管内科,急性心肌梗死早期预警和干预北京市重点实验室,心血管转化医学研究中心,北京市100044

出　　处：《中国超声医学杂志》2022年第4期398-401,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用心脏声学造影技术评价急性ST段抬高型心肌梗死患者介入术后心肌灌注水平,并分析其与心功能的相关性。方法回顾性分析因急性ST段抬高型心肌梗死(STEMI)入院接受经皮冠状动脉介入治疗(PCI)并在术后48h内完成心脏声学造影检查的患者152例。根据声学造影下所测得的左室射血分数(LVEF)将患者分为正常组和降低组。分析两组患者的临床资料、冠脉情况和超声指标。结果①152例急性STEMI患者介入术后48h内存在LVEF下降的比例为38.8%。②与正常组相比,射血分数下降患者的罪犯血管多为前降支,左室显著增大,左室长轴应变(GLS)显著下降,室壁运动积分(WMSI)和心肌灌注积分(CSI)显著升高。心肌灌注异常的比例在降低组显著升高(78.0%比45.2%,P=0.000)。③GLS和WMSI对LVEF下降的诊断价值最高。CSI的诊断力度弱于二者但仍有统计学意义,CSI>1.21诊断LVEF下降的灵敏度为61.8%、特异度为78.3%(AUC=0.738,P=0.000)。结论急性STEMI患者PCI术后发生心肌灌注异常的比例较高,相较于CSI,GLS和WMSI对心功能有更好的诊断价值。Objective To evaluate the myocardial perfusion level in the patients with acute ST-segment elevation myocardial infarction after intervention,and to analyze its correlation with cardiac function.Methods Data of 152 patients admitted for acute ST-segment elevation myocardial infarction(STEMI)were collected and retrospective analyzed.All of the patients received percutaneous coronary intervention(PCI)and completed MCE within 48 hours.According to the measured left ventricular ejection fraction(LVEF),the patients were divided into normal group and reduced group.The clinical coronary artery condition and echocardiographic data were analyzed.Results(1)In 152 patients with STEMI after intervention within 48 hrs,the proportion of LVEF decreased was 38.8%.(2)Compared with the normal group,the patients with decreased LVEF had significantly higher BNP,more anterior descending branch lesions,increased size of left ventricle,decreased left ventricular long axis strain(GLS),and significantly increased ventricular wall motion score(WMSI)and myocardial perfusion score(CSI).(3)GLS and WMSI had the highest diagnostic value for LVEF decreased.The sensitivity and specificity of CSI>1.21 in the diagnosis of decreased LVEF were 61.8%and 78.3%respectively(AUC=0.738,P=0.000).Conclusions The incidence of decreased myocardial perfusion level in acute STEMI patients after PCI is relatively high.Compared with CSI,GLS and WMSI have better diagnostic value for cardiac function.

关 键 词：急性ST段抬高型心肌梗死 心脏声学造影 射血分数 心肌灌注 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.22[医药卫生—诊断学]