摘要
目的采用二维斑点追踪成像(2D-STI)技术探讨急诊经皮冠状动脉介入治疗(PCI)的症状开始至球囊扩张时间(SOTBT)对ST段抬高型心肌梗死(STEMI)患者局部心功能预后的影响。方法选取2014年7月至2016年7月在黄石市中心医院首次诊断为STEMI并接受急诊PCI手术的患者60例,根据SOTBT分为SOTBT≤6 h心肌梗死组、6 h<SOTBT<12 h心肌梗死组,另选取30名健康人作为健康对照组。术后24 h、术后1个月分别进行2D-STI检查,测量心肌纵向应变(LS)、圆周应变(CS)及径向应变(RS)参数。SOTBT≤6 h心肌梗死组、6 h<SOTBT<12 h心肌梗死组与健康对照组3组间临床和冠状动脉造影情况及二维应变参数比较采用单因素方差分析,组间比较LSD-t检验。应变参数与SOTBT的相关性采用Pearson直线相关分析。结果术后24 h,6 h<SOTBT<12 h心肌梗死组LS、CS、RS均低于健康对照组,差异有统计学意义(t=5.12,4.78,2.95,P<0.05);而SOTBT≤6 h心肌梗死组仅LS、CS低于健康对照组,差异有统计学意义(t=5.63,4.33,P<0.05)。相关分析发现△LS、△CS与SOTBT显著正相关(r=0.711,0.623,P<0.01)。采用LS预测存活心肌的ROC曲线下面积最大(AUC=0.728,P<0.01),在阈值为-17.92%时,敏感度为62.9%,特异度为64.0%。结论 2D-STI技术可以评价ST段抬高型心肌梗死患者局部心肌应变,并能识别SOTBT对STEMI患者预后的影响,LS是最敏感的应变参数。
Objective To explore the emergency PCI symptom-onset-to-balloon time （SOTBT） influence on the local cardial function in patients with acute ST-segment elevation myocardial infarction （STEMI） by two-dimensional speckle tracking imaging （2D-STI） technology. Methods Sixty cases were first diagnosed with ST-elevation myocardial infarction （STEMI） and undergone emergency PCI surgery in Huangshi central hospital from June 2014 to June 2016. According to SOTBT, patients were divided into two groups： SOTBT ≤ 6h myocardial infarction group, 6 h 〈 SOTBT 〈 126 h myocardial infarction group. Thirty cases of healthy subjects were as normal control group. Twenty-four hours and one month after surgery, echocardiographic examinations were performed. To measure myocardial longitudinal strain （LS）, circumferential strain （CS） and radial strain （RS）. One-way ANOVA and LSD test were used to analyze the clinical and angiographic characteristics, two-dimensional strain parameters among two myocardial infarction groups and the healthy controls group. Line correlation analysis was applied to dispose the relativity between the two-dimensional strain parameters and SOTBT. Results After 24 hours, Longitudinal and circumferential and radial strain of the 6 h 〈 SOTBT 〈 126 h MI group were lower than normal control group, the difference was statistically significant （t=4.53, 3.76, 2.59, P 〈 0.05）. But only longitudinal and circumferential strain of the SOTBT ≤ 6 h MI group were lower than the healthy group, the difference was statistically significant （t=3.13, 2.17, P 〈 0.01）. The area under the ROC curve of LS to predict survival myocardium is biggest （AUC=0.728, P 〈 0.01）. And when the cut off valve was -17.92%, the sensitivity was 62.9%, the specificity was 64.0%. Conclusions 2D-STI can evaluate local myocardial strain of patients with STEMI, and identify the symptoms-onset-to-balloon time influence on the prognosis of patients with STEMI. The longitudinal strain is the most sensitive strain parameter.
作者
洪玮
赵刚
韩鄂辉
吕志红
胡小娟
张凯
Hong Wei Zhao Gang Han Ehui Lyu Zhihong Hu Xiaojuan Zhang Kai(Deptartment of Ultrasound Department of Intervention Department of Cardiology, the Central Hospital of Huangshi （Affiliated Hospital of Hubei Polytechnic university）, Huangshi 435000, China)
出处
《中华医学超声杂志（电子版）》
CSCD
2016年第12期893-897,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
超声检查
心肌梗塞
冠状动脉狭窄
Ultrasonography
Myocardial infarction
Coronary stenosis
