无创心肌做功定量评估冠状动脉介入治疗术后患者早期左心室功能改变的临床研究  

Assessment of early left ventricular function changes after percutaneous coronary intervention by non-invasive myocardial work

作　　者：秦芸芸 李一丹[1] 吴小朋 蔡绮哲[1] 王江涛 丁雪晏 林明明 吕秀章[1] Qin Yunyun;Li Yidan;Wu Xiaopeng;Cai Qizhe;Wang Jiangtao;Ding Xueyan;Lin Mingming;Lyu Xiuzhang(Department of Echocardiography,Beijing Chao Yang Hospital Capital Medical University,Beijing 100020,China;Department of Heart Center,Beijing Chao Yang Hospital Capital Medical University,Beijing 100020,China;GE Clinical Education Team,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏超声科,北京100020 [2]首都医科大学附属北京朝阳医院心脏中心,北京100020 [3]通用电气医疗心血管超声临床科研部,北京100176

出　　处：《中华超声影像学杂志》2022年第7期585-590,共6页Chinese Journal of Ultrasonography

基　　金：北京市医院管理局临床技术创新项目(XMLX201827);国家自然科学基金(82001815)。

摘　　要：目的应用无创心肌做功定量评估左室射血分数(LVEF)正常的无明显节段性室壁运动异常的非ST段抬高型急性冠状动脉综合征(NSTE-ACS)成功行经皮冠状动脉介入治疗(PCI)后患者左室心肌功能,探讨PCI术后患者左室心肌功能恢复演变。方法选取首都医科大学附属北京朝阳医院2019年7-12月92例LVEF正常(>55%)且无明显节段性室壁运动异常的成功行PCI治疗的NSTE-ACS患者,分别于术前1 d和术后1 d、2周、1个月、3个月行超声心动图检查。分析左室整体纵向应变(GLS),以袖带血压作为左室收缩末压构建无创左室压力-应变环,比较术后各组间左室整体心肌做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)、整体做功效率(GWE)的差异,探讨心肌做功参数的相关性。结果与术前相比,PCI术后1 d GWI、GCW、GWE改善(均P<0.05),2周后GLS升高(P<0.05),GWW降低(P<0.05),1个月后LVEF改善(P<0.05)。基线GWI、GCW与GLS呈中等负相关(r=-0.67、-0.66,均P<0.05);GWW与机械离散度(MD)、收缩后收缩指数(PSI)呈中等正相关(rs=0.45、0.50,均P<0.05);GWE与GLS、MD及PSI呈中等负相关(rs=-0.47、-0.55、-0.56,均P<0.05)。结论LVEF正常且无明显节段性室壁运动异常的NSTE-ACS患者成功行PCI术后左室心肌功能逐步改善,心肌做功参数较GLS和LVEF变化更敏感,可用于PCI术后早期左室心肌功能变化的定量评估。Objective To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome(NSTE-ACS)patients with normal wall motion and left ventricular ejection fraction(LVEF)after percutaneous coronary intervention(PCI)by noninvasive myocardial work technology,and to explore the evolution of left ventricular myocardial function recovery.Methods A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF(>55%)after PCI were recruited.Echocardiography was performed 1 day before PCI,1 day,2 weeks,1 month,and 3 months after PCI.Global longitudinal strain(GLS)was analyzed,and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop.Global myocardial work index(GWI),global constructive work(GCW),global waste work(GWW),global myocardial work efficiency(GWE)among groups were compared and their correlations with strain parameters were explored.Results GWI,GCW,GWE were improved(P<0.05)at 1 day after PCI,GLS improved(P<0.05)and GWW decreased(P<0.05)at 2 weeks,LVEF improved(P<0.05)at 1 month.Baseline GWI and GCW had a moderately negative correlation with GLS(r=-0.67,-0.66;both P<0.05);GWW had a moderately positive correlation with mechanical dispersion(MD)and postsystolic shortening index(PSI)(rs=0.45,0.50;both P<0.05);GWE had a moderately negative correlation with GLS,MD and PSI(rs=-0.47,-0.55,-0.56;all P<0.05).Conclusions Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI.Myocardial work parameters changes are more sensitive than GLS and LVEF,and can assess early left ventricular myocardial function changes after PCI.

关 键 词：斑点追踪超声心动图 非ST段抬高型急性冠状动脉综合征 经皮冠状动脉介入治疗 左室压力-应变环 心肌做功 

分 类 号：R541.4[医药卫生—心血管疾病]