超声多模态成像对心肌梗死患者缺血节段识别及左心功能评估的作用  

Ultrasonic multimodal imaging in the identification of ischemic segments and the evaluation of left ventricular function in patients with myocardial infarction

作　　者：刘建平 洪丹丹[1] 邱金梅 郑美端 LIU Jianping;HONG Dandan;QIU Jinmei;ZHENG Meiduan(Department of Echocardiography,Quanzhou First Hospital,Quanzhou,Fujian362000,China)

机构地区：[1]福建省泉州市第一医院心脏彩超室,泉州362000

出　　处：《福建医药杂志》2024年第2期14-18,共5页Fujian Medical Journal

摘　　要：目的探讨联合应用经胸超声心动图(TTE)、二维斑点追踪成像技术(2D-STI)及肺超声对不同类型心肌梗死(MI)缺血节段识别、左心功能评估的临床应用价值。方法随机选取福建省泉州市第一医院心内科MI患者93例,其中非ST抬高型心梗(NSTEMI)45例、ST抬高型心梗(STEMI)48例。所有患者均在冠脉造影前24 h内行TTE、2D-STI及肺超声检查;TTE观察是否有节段性室壁运动异常(RWMA),并测量左室射血分数(LVEF)、左房容积指数(LAVI)、肺动脉收缩压(PASP)、二尖瓣血流E峰、二尖瓣环e'峰并计算E/e';2D-STI分析左室壁各节段心肌纵向峰值应变(LPS)、整体纵向峰值应变(GLPS);肺超声观察并计算肺B线积分;入院时急查B型钠肽(BNP)。比较TTE、2D-STI判断为缺血节段与冠脉造影结果的符合率;分析两组患者TTE参数、GLPS、肺B线积分及BNP间的相关性。结果NSTEMI组2D-STI缺血节段符合率较TTE升高(P<0.05);在NSTEMI组,LVEF与GLPS、肺B线积分、BNP呈弱相关性,而在STEMI组均呈较强的相关性;在两组患者中,GLPS、肺B线积分均与BNP呈较强的正相关关系,肺B线积分与E/e'、LAVI、PASP相关性较强。结论TTE联合2D-STI能提高NSTEMI患者缺血节段的识别率;联合肺超声能为MI患者左心功能及肺淤血程度的评估提供客观的影像学依据;对MI患者进行超声多模态成像具有一定的临床意义。Objective To investigate the clinical application value of transthoracic echocardiography(TTE),two-dimensional speckle tracking imaging(2D-STI)and lung ultrasound in the identification of ischemic segments and assessment of left ventricular function in different types of myocardial infarction(MI).Methods A total of 93 patients with MI in the Cardiology Department of Quanzhou First Hospital were randomly selected,including 45 cases of NSTEMI and 48 cases of STEMI.All patients underwent TTE,2D-STI,and lung ultrasound within 24 hours prior to coronary angiography.TTE was used to observe whether there was regional wall motion abnormalities(RWMA),and the left ventricular ejection fraction(LVEF),left atrial volume index(LAVI),pulmonary artery systolic blood pressure(PASP),mitral valve flow E peak,mitral annulus e'peak were measured and E/e'was calculated.2D-STI was used to analyze the longitudinal peak strain(LPS)and global longitudinal peak strain(GLPS)of each segment of the left ventricular wall;Pulmonary ultrasound was used to observe and calculate the B-line integral of the lungs;B-type natriuretic peptide(BNP)was urgently checked upon admission.The coincidence rate between STE and 2D-STI was compared with the results of coronary angiography,and the correlation between TTE parameters,GLPS,lung B-line score and BNP in the two groups was analyzed.Results The coincidence rate of 2D-STI ischemia segment in the NSTEMI group was significantly higher than that of TTE(P<0.05),LVEF was weakly correlated with GLPS,lung B-line integral and BNP in the NSTEMII group,but the correlation were strong in the STEMI group.GLPS and pulmonary B-line scores were strongly positively correlated with BNP,and pulmonary B-line scores were strongly correlated with E/e',LAVI and PASP in the two groups.Conclusion TTE combined with 2D-STI can improve the identification rate of ischemic segments in patients with NSTEMI;TTE combining with lung ultrasound can provide an objective imaging basis for the evaluation of left heart function and pulmonary

关 键 词：心肌梗死 节段性室壁运动异常 二维斑点追踪显像 左心功能 肺超声 

分 类 号：R445[医药卫生—影像医学与核医学]