三维超声心动图和二维斑点追踪成像评估老年急性心肌梗死患者的左心室收缩功能  

Evaluation of left ventricular systolic function in elderly patients with AMI by RT-3DE and 2-D speckle tracking imaging

作　　者：刘睿涵 刘涛[2] 黄鑫[1] 杨明艳 马宇飞 洛佳坤 于焱 曹剑[1] 邓玉姣 Liu Ruihan;Liu Tao;Huang Xin;Yang Mingyan;Ma Yufei;Luo Jiakun;Yu Yan;Cao Jian;Deng Yujiao(Department of Cardiology,Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]北京解放军总医院第二医学中心心血管内科国家老年疾病临床研究中心,北京100853 [2]北京解放军总医院第二医学中心超声科国家老年疾病临床研究中心,北京100853 [3]北京解放军总医院第一医学中心超声科国家老年疾病临床研究中心,北京100853

出　　处：《中华老年心脑血管病杂志》2022年第10期1059-1063,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的应用实时三维超声心动图和二维斑点追踪成像动态评估非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI)的老年患者左心室收缩功能。方法前瞻性纳入2021年1~6月解放军总医院第二医学中心心血管内科住院的老年AMI患者80例,根据PCI术后结果分为NSTEMI组40例,STEMI组40例。另选择老年健康志愿者40例为对照组。NSTEMI组和STEMI组分别于PCI术后1周和术后3个月行超声心动图检查。选择性冠状动脉造影证实梗阻相关动脉心肌节段。用4D LV Volume Tom Tec软件测量获得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏量和LVEF。应用应变分析软件获得梗阻相关动脉心肌节段的左心室纵向收缩期峰值应变(LPSS)、径向收缩期峰值应变(RPSS)、周向收缩期峰值应变(CPSS)、左心室底部旋转峰度(rot_base)、左心室尖部旋转峰度(rot_(apex))和扭曲度。结果与对照组比较,NSTEMI组和STEMI组术后1周LVESV和LVEDV明显升高,术后1周和3个月LVEF明显降低(P<0.05)。NSTEMI组术后1周和3个月梗阻相关动脉心肌节段LPSS、CPSS、rot_base、rot_(apex)和扭转值明显高于STEMI组(P<0.05);NSTEMI组术后3个月RPSS明显高于STEMI组[(25.68±13.00)%vs(19.27±10.08)%,P<0.05]。STEMI组和NSTEMI组术后3个月RPSS、CPSS、rot_base、rot_(apex)和扭转值较术后1周明显改善(P<0.01)。结论实时三维超声心动图和二维斑点追踪成像能敏感地评价不同程度透壁损伤的老年急性心肌梗死患者左心室收缩功能。Objective To apply real-time 3-D echocardiography(RT-3 DE) and 2-D speckle tracking imaging(STI) to assess left ventricular systolic function in elderly patients with NSTEMI and STEMI.Methods A total of 80 elderly patients with AMI hospitalized in Department of Cardiology of Second Medical Center of Chinese PLA General Hospita from January to June 2021 were prospectively recuited, and divided into 40 cases in the NSTEMI group and 40 cases in the STEMI group according to the outcome after PCI.Another 40 elderly healthy volunteers were selected as the control group.Echocardiography was performed in the NSTEMI group and STEMI group in 1 week and 3 months after PCI,respectively.Selective coronary angiography was performed to confirm the myocardial segment of the infarct-related arteries.LVEDV,LVESV,stroke volume, and LVEF were obtained using 4 D LV Volume Tom Tec software.Strain analysis software was applied to obtain LPSS,RPSS,CPSS,left ventricular base rotational kurtosis(rot_(apex)),left ventricular apical rotational kurtosis(rot_(apex)),and twist for the myocardial segments of the obstruction-related arteries.Results Compared with the control group, the values of LVESV and LVEDV were significantly higher in the NSTEMI and STEMI groups at 1 week postoperatively, and LVEF value was obviously lower at 1 week and 3 months postoperatively(P<0.05).The values of LPSS,CPSS,rot_(apex),rot_(apex)and torsion of myocardial segments of infarct-related arteries were significantly higher in the NSTEMI group than the STEMI group at 1 week and 3 months post-operatively(P<0.05).The RPSS value was significantly higher in the NSTEMI group than the STEMI group at 3 months postoperatively [(25.68±13.00)% vs(19.27±10.08)%,P<0.05].The values of RPSS,CPSS,rot_(apex),rot_(apex)and torsion were significantly improved in the STEMI and NSTEMI groups at 3 months postoperatively when compared with those at 1 week postoperatively(P<0.01).Conclusion RT-3 DE and 2-D STI can sensitively evaluate the LV systolic function with various transmural i

关 键 词：超声心动描记术 三维 心肌梗死 心室功能 左 冠状血管造影术 心肌缺血 

分 类 号：R542.22[医药卫生—心血管疾病]