血流向量成像技术评估择期经皮冠状动脉介入治疗术后患者舒张期左心室内压差  

Vector Flow Mapping in Assessing Diastolic Left Ventricular Pressure Difference in Patients After Elective Percutaneous Coronary Intervention

作　　者：郑岸生 孙雪[1] 秦志平[1] 王艳[1] 张晓光[1] 喻红霞[1] ZHENG Ansheng;SUN Xue;QIN Zhiping;WANG Yan;ZHANG Xiaoguang;YU Hongxia(Department of Ultrasound Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]郑州大学第二附属医院超声医学科,河南郑州450002

出　　处：《中国医学影像学杂志》2023年第7期713-719,共7页Chinese Journal of Medical Imaging

摘　　要：目的应用血流向量成像的相对压成像技术评估择期经皮冠状动脉介入治疗(PCI)后患者舒张期左心室内压力差(IVPD)及左心室内压力梯度(IVPG),探讨其评估PCI术后疗效及作为评价冠心病患者舒张功能的临床价值。资料与方法前瞻性分析2022年3—6月郑州大学第二附属医院心内科择期行PCI的51例左心室射血分数正常的冠心病患者,以健康查体志愿者46例为对照组。常规测量所有研究对象的收缩与舒张功能参数,采用血流向量成像技术测得等容舒张期(IR)、快速充盈期(RF)、缓慢充盈期(SF)和心房收缩期(AC)的IVPD和IVPG。分析对照组、PCI组术前3 d、PCI组术后1周心功能参数、舒张期IVPD及IVPG的变化特征,并分析舒张期IVPD及IVPG与常规舒张功能参数的相关性。结果PCI组术前3 d舒张早期二尖瓣口峰值流速(E)、E/A、左心室射血分数、二尖瓣环间隔和侧壁在舒张早期的平均速度(e')及整体纵向应变绝对值低于对照组,左心房容积指数、左心室舒张末期容积指数、左心室收缩末期容积指数、舒张晚期二尖瓣口峰值流速(A)、E/e'均高于对照组(t=5.51、-27.36、11.23、7.82、14.86、-17.38、-4.13、-10.65、-7.30、9.11,P<0.001)。PCI术后1周与术前3 d比较,左心房容积指数、E/e'减低,e'增高(t=2.87、-6.74、2.51,P均<0.05)。PCI术前3 d IR期、RF期、SF期、AC期IVPD(t=34.79、12.45、7.88、13.69)和IVPG(t=13.03、8.18、5.64、13.01)均低于对照组(P<0.001),术后1周各期IVPD(t=-18.03、-2.58、-5.23、-7.05)和IVPG(t=-7.14、-2.84、-2.63、-5.89)均高于术前3 d(P<0.05)。IR期IVPD和IVPG(r=0.548、0.385)、AC期IVPD和IVPG(r=0.450、0.453)分别与e'呈正相关(P均<0.01),分别与左心房容积指数和E/e'呈负相关(IR期:r=-0.776、-0.577、-0.797、-0.699;AC期:r=-0.614、-0.550、-0.660、-0.567;P均<0.01),且相关性较RF期和SF期好。结论相对压成像技术实现了心导管技术指标IVPD和IVPG的无创化直观准确定Purpose Relative pressure imaging(RPI)with vector flow mapping was applied to assess the left intraventricular pressure difference(IVPD)and left intraventricular pressure gradient(IVPG)during diastole in patients after elective percutaneous coronary intervention(PCI),to investigate its clinical data in assessing the efficacy of post-PCI and as an evaluation of diastolic function in patients with coronary artery disease.Materials and Methods Fifty-one patients with coronary artery disease with normal left ventricular ejection fraction who underwent elective PCI in Department of Cardiology,Second Affiliated Hospital of Zhengzhou University from March to June 2022 and 46 healthy check-up volunteers as controls were prospectively selected.The systolic and diastolic functional parameters of all subjects were routinely measured,the IVPD and IVPG of isovolumetric relaxation period(IR),rapid filling period(RF),slow filling period(SF)and atrial contraction period(AC)were measured via the vector flow mapping technique.The changes in cardiac functional parameters,diastolic IVPD and IVPG were analyzed among the control group,the PCI group of three days before surgery and the PCI group of one week after surgery.The correlation between diastolic IVPD and IVPG and conventional diastolic functional parameters was analyzed.Results The absolute values of peak early diastolic mitral orifice velocity(E),E/A,left ventricular ejection fraction,mean mitral annular septal and lateral velocities in early diastole(e')and overall longitudinal strain of the PCI group of three days before surgery were significantly lower than those of the control group,while the left atrial volume index,left ventricular end-diastolic volume index,left ventricular end-systolic volume index,peak late diastolic mitral orifice velocity(A)and E/e'of the PCI group of three days before surgery were significantly higher than those of the control group(t=5.51,-27.36,11.23,7.82,14.86,-17.38,-4.13,-10.65,-7.30,9.11;P<0.001).Left atrial volume index,E/e'of PCI group of

关 键 词：冠状动脉病变 经皮冠状动脉介入治疗 心室压 心室功能 左 超声心动描记术 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]