收缩后收缩和收缩早期伸长对ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后心肌微循环灌注不良的诊断价值  

Postsystolic shortening and early systolic lengthening to diagnose myocardial microvascular dysfunction in patients with ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

作　　者：袁文悦 周燕翔 李明奇 宋宏宁[1] 曹省[1] 郭瑞强[1] Yuan Wenyue;Zhou Yanxiang;Li Mingqi;Song Hongning;Cao Sheng;Guo Ruiqiang(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,武汉430060

出　　处：《中华超声影像学杂志》2022年第9期759-766,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82102046);中央高校基本科研业务费专项资金(2042021kf0121)。

摘　　要：目的应用收缩后收缩(PSS)和收缩早期伸长(ESL)诊断急性ST段抬高型心肌梗死(STEMI)患者在急诊经皮冠状动脉介入治疗(PCI)术后的心肌微循环灌注状况。方法回顾性收集2021年6-10月入住武汉大学人民医院且接受急诊PCI的STEMI患者83例,于术后7 d内对所有患者行常规超声心动图和心肌声学造影(MCE)检查。根据整体心肌灌注评分指数(MPSI)将患者分为整体灌注正常组与整体灌注不良组;将左室心肌分为左前降支(LAD)、左回旋支(LCx)和右冠状动脉(RCA)供血区域,并根据有无灌注不良将各区域心肌分为区域灌注正常组与区域灌注不良组。使用改良双平面Simpson法测量左室收缩末期容积(LVESV)及左室射血分数(LVEF)。应用TomTec软件分析,获取常规超声参数、整体纵向应变(GLS)及PSS和ESL参数:收缩后指数(PSI)、收缩后收缩持续时间(PSSduration)、收缩早期指数(ESI)和收缩早期伸长持续时间(ESLduration)。比较术后整体灌注不良组与整体灌注正常组间各参数间的差异,以及区域灌注不良组与区域灌注正常组间各参数间的差异,并用ROC曲线分析PSS和ESL参数及GLS对心肌微循环灌注不良的诊断价值。结果①整体灌注不良组与整体灌注正常组间LVEF、LVESV、GLS、PSI、ESI和PSSduration差异有统计学意义(均P<0.05)。②LAD和LCx供血区域中,区域灌注不良组PSI、ESI和ESLduration的绝对值高于区域灌注正常组(均P<0.05);RCA供血区域中,区域灌注不良组仅有PSI绝对值高于区域灌注正常组(P<0.05)。③对于不同心肌区域的GLS,仅有LAD-GLS绝对值在区域灌注不良组低于区域灌注正常组(P<0.05)。④ROC曲线分析结果显示,对于诊断不同区域的心肌微循环灌注不良,LAD-PSI、LAD-GLS、LCx-PSI、LCx-ESLduration和RCA-PSI均有较高价值,其中LAD-PSI的曲线下面积(AUC=0.809)最大。结论PSS和ESL参数有助于早期诊断STEMI患者PCI术后心肌微循环灌注的状况,并提供�Objective To investigate the diagnostic value of postsystolic shortening(PSS)and early systolic lengthening(ESL)on myocardial microvascular dysfunction in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 83 patients with STEMI who received emergency PCI in Renmin Hospital of Wuhan University from June to October 2021 were retrospectively collected.All patiets underwent two-dimensional echocardiography and myocardial contrast echocardiography(MCE)within 7 days after PCI.The patients were divided into global normal perfusion group and poor perfusion group according to global myocardial perfusion score index(MPSI).Left ventricular myocardium was divided into left anterior descending branch(LAD),left circumflex branch(LCx)and right coronary artery(RCA)regions,which were divided into regional normal perfusion group and poor perfusion group based on whether there were segments with microvascular dysfunction.Left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)were measured by modified biplane Simpson method.Tomtec software was used to obtain conventional echocardiographic parameters,global longitudinal strain(GLS),as well as PSS and ESL parameters including postsystolic index(PSI),duration of postsystolic shortening(PSSduration),early systolic index(ESI)and duration of early systolic lengthening(ESLduration).Differences of parameters of global normal and poor perfusion groups,as well as regional normal and poor perfusion groups were compared.ROC curve was used to analyze the diagnostic value of PSS and ESL parameters and GLS in myocardial regions with microvascular dysfunction.Results Significant differences were observed in LVEF,LVESV,GLS,PSI,ESI and PSSduration between global poor perfusion group and global normal perfusion group(all P<0.05).Compared with regional normal perfusion group,PSI,ESI and ESLduration of LAD and LCx regions,as well as PSI of RCA region in regional poor perfusion group were increas

关 键 词：二维斑点追踪成像技术 急性心肌梗死 经皮冠状动脉介入治疗 收缩后收缩 收缩早期伸长 心肌灌注 

分 类 号：R542.22[医药卫生—心血管疾病]