腺苷负荷超声心动图联合左室压力-应变环预测经皮冠状动脉介入治疗术后支架内再狭窄程度的临床价值  

Clinical value of adenosine stress echocardiography combined with left ventricular pressure-strain loop in predicting the degree of in-stent restenosis after percutaneous coronary intervention

作　　者：达文会 丁云川[1] 王庆慧[1] 赵丽[1] 许彭黎 李井池 DA Wenhui;DING Yunchuan;WANG Qinghui;ZHAO Li;XU Pengli;LI Jingchi(Department of Ultrasound Medicine,Yan’an Hospital Affiliated to Kunming Medical University,Kunming 650051,China)

机构地区：[1]昆明医科大学附属延安医院超声医学科,昆明市650051

出　　处：《临床超声医学杂志》2024年第8期636-640,共5页Journal of Clinical Ultrasound in Medicine

基　　金：昆明市卫生健康委员会卫生科研课题项目(2022-09-02-001)。

摘　　要：目的应用腺苷负荷超声心动图(ASE)联合左室压力-应变环(LVPSL)检测经皮冠状动脉介入治疗(PCI)术后支架内再狭窄心肌节段做功参数,探讨其在预测冠状动脉再狭窄程度中的临床应用价值。方法选取我院经冠状动脉造影确诊的PCI术后支架内再狭窄患者41例,排除腺苷负荷前后图像不满意的12个节段,共获得726个心肌节段,其中狭窄程度<50%的节段300个(无明显狭窄组)、狭窄程度50%~75%的节段175个(中度狭窄组),狭窄程度>75%的节段251个(重度狭窄组),比较各组基础及负荷状态下心肌节段纵向应变(LS)、心肌有用功(CMW)、心肌无用功(WW)、心肌做功指数(MWI)及心肌做功效率(MWE)的差异。绘制受试者工作特征(ROC)曲线分析基础及负荷状态下各心肌做功参数预测PCI术后冠状动脉重度狭窄的诊断效能。结果与无明显狭窄组比较,中度狭窄组基础及负荷状态下LS、MWI、MWE、CMW均减低,WW增加,重度狭窄组基础及负荷状态下LS、MWI、MWE、CMW均减低,负荷状态下WW增加,差异均有统计学意义(均P<0.01);与中度狭窄组比较,重度狭窄组负荷状态下LS、MWI、MWE、CMW均减低,WW增加,差异均有统计学意义(均P<0.01)。与基础状态下比较,无明显狭窄组和中度狭窄组负荷状态下LS、MWI、MWE、CMW均增加,WW减低,差异均有统计学意义(均P<0.05);重度狭窄组负荷状态下LS、MWI、MWE、CMW均减低,WW增加,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,负荷状态下MWI、MWE、CMW预测PCI术后冠状动脉重度狭窄的曲线下面积(AUC)分别为0.829、0.766、0.841,均高于基础状态下各参数的AUC高,且负荷状态下CMW预测PCI术后冠状动脉重度狭窄的AUC高于负荷状态下MWE、WW的AUC,差异均有统计学意义(均P<0.001);负荷状态下CMW与MWI预测PCI术后冠状动脉重度狭窄的AUC比较差异无统计学意义。结论ASE联合LVPSL可有效评估PCI术后再狭窄心肌节段的做功情况,�Objective To measure the myocardial work parameters of myocardial segments with in-stent restenosis after percutaneous coronary intervention(PCI)by adenosine stress echocardiography(ASE)combined with pressure-strain loop(LVPSL),and to explore its clinical application value for predicting the degree of coronary artery restenosis.Methods Fortyone patients with in-stent restenosis after PCI diagnosed by coronary angiography were selected from our hospital,excluding the 12 segments with unsatisfactory images before and after adenosine loading,a total of 726 myocardial segments were obtained,of which 300 segments with a stenosis degree of<50%(no significant stenosis group),175 segments with a stenosis degree of 50%~75%(moderate stenosis group)and 251 segments with a stenosis degree of>75%(severe stenosis group),and the differences of longitudinal strain(LS),constructive myocardial work(CMW),wasted work(WW),myocardial work index(MWI)and myocardial work efficiency(MWE)of myocardial segments among groups were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of each parameters at basal and loading states for evaluating severe coronary artery stenosis after PCI.Results Compared with no significant stenosis group,LS,MWI,MWE and CMW decreased and WW increased at basal and loading states in moderate stenosis group,and LS,MWI,MWE and CMW decreased at basal and loading states in severe stenosis group,and WW increased at loading state,and the differences were statistically significant(all P<0.01).Compared with the moderate stenosis group,LS,MWI,MWE,CMW decreased and WW increased at loading state in severe stenosis group,and the differences were statistically significant(all P<0.01).Compared with the basal state,LS,MWI,MWE,CMW increased and WW decreased at loading state in no significant stenosis group and moderate stenosis group,and the differences were statistically significant(all P<0.05).In the Severe stenosis group,LS,MWI,MWE,CMW decreased and WW increased at loading state,and

关 键 词：超声心动描记术 腺苷负荷 心肌做功 经皮冠状动脉介入治疗 支架内再狭窄 

分 类 号：R540.45[医药卫生—心血管疾病] R541.4[医药卫生—内科学]