实时心肌超声造影结合二维应变评价急性心肌梗死介入术后心肌灌注与收缩功能  

Evaluation of myocardial perfusion and systolic function after interventional therapy for acute myocardial infarction by realtime myocardial contrast echocardiography combined with two-dimensional strain

作　　者：焦晓芳 刘楠楠 周微微 李阳 王艳秋 李贵申 JIAO Xiao-fang;LIU Nan-nan;ZHOU Wei-wei;LI Yang;WANG Yan-qiu;LI Gui-shen(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第12期1227-1230,1236,共5页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金计划项目(20180550235)。

摘　　要：目的探讨应用实时心肌超声造影(MCE)结合二维应变成像(2DS)评价急性心肌梗死术后心肌灌注与收缩功能的变化情况。方法选取自2021年6月至2022年12月北部战区总医院胸痛中心收治的58例接受直接经皮冠状动脉介入术(PCI)的急性前壁心肌梗死患者为研究对象。所有研究对象经冠状动脉造影证实为前降支狭窄≥90%,其他冠状动脉血管狭窄<50%,研究对象于术后1周内行实时MCE、2DS及常规超声心动图检查,术后3个月行2DS及常规超声心动图检查。应用2DS测量左室各节段收缩期纵向峰值应变及左心室整体纵向峰值应变(GLS);应用常规超声心动图检查测量左室舒张末期内径(LVDD)及左心室射血分数(LVEF);应用MCE目测法半定量分析将患者分为灌注良好组、灌注减弱组和无灌注组。比较各灌注组术后1周内、术后3个月GLS、LVDD、LVEF。结果58例急诊AMI患者支架术后均完成心肌造影检查,其中,灌注良好22例(灌注良好组),灌注减弱19例(灌注减弱组),无灌注17例(无灌注组)。术后3个月,灌注良好组、灌注减弱组的LVEF、GLS均高于术后1周内,差异有统计学意义(P<0.05);灌注良好组、灌注减弱组的LVDD均低于术后1周内,但差异无统计学意义(P>0.05);无灌注组的LVEF、GLS均低于术后1周内,LVDD高于术后1周内,但差异均无统计学意义(P>0.05)。术后3个月,心肌灌注良好组的LVEF、GLS高于灌注减弱组和无灌注组,且灌注减弱组的LVEF、GLS高于无灌注组,差异均有统计学意义(P<0.05)。结论实时MCE评价急性心肌梗死PCI术后心肌灌注可以反映心肌功能恢复情况,2DS可以定量评估整体及局部心肌收缩功能。Objective To evaluate the changes of myocardial perfusion and systolic function after acute myocardial infarction by realtime myocardial contrast-enhanced ultrasound(MCE)combined with two-dimensional strain imaging(2DS).Methods A total of fiftyeight patients with acute anterior myocardial infarction who underwent direct percutaneous coronary intervention(PCI)in the Chest Pain Center of General Hospital of Northern Theater Command from June 2021 to December 2022 were selected as the study subjects.All subjects were confirmed by coronary angiography to have anterior descending branch stenosis≥90%,and other coronary artery stenosis<50%.The subjects underwent real-time MCE,2DS and routine echocardiography within 1 week after surgery,and 2DS and routine echocardiography 3 months after surgery.Real-time MCE,2DS and conventional cardiography were performed within 1 week after surgery,and 2DS and conventional echocardiography were performed 3 months after surgery.The longitudinal peak systolic strain and the global longitudinal strain(GLS)of left ventricle were measured by 2DS.Left ventricular end-diastolic diameter(LVDD)and left ventricular ejection fraction(LVEF)were measured by conventional echocardiography.The patients were divided into good perfusion group,impaired perfusion group and no perfusion group by MCE visual semi-quantitative analysis.GLS,LVDD and LVEF of each perfusion group were compared 1 week and 3 months after surgery.Results Myocardial angiography was performed after stenting in all 58 patients with emergency AMI.Among them,22 cases had good perfusion(good perfusion group),19 cases had weakened perfusion(weakened perfusion group),and 17 cases had no perfusion(no perfusion group).At 3 months after surgery,LVEF and GLS in good perfusion group and weakened perfusion group were higher than those in 1 week after surgery,the difference was statistically significant(P<0.05).LVDD in good perfusion group and weakened perfusion group was lower than that in 1 week after surgery,but the difference was not stati

关 键 词：急性心肌梗死 心肌灌注 应变 微循环 心肌收缩 

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]