摘要
目的探讨实时三维超声心动图评价心肌梗死患者经皮冠状动脉介入治疗(PCI)前后左室收缩功能的应用价值。方法应用实时三维超声心动图获得120例正常成人(正常组)心脏左室壁17节段心肌纵向应变、径向应变、圆周向应变和面积应变的正常值,另选45例心肌梗死患者,应用冠状动脉造影判断心肌梗死部位和范围,实时三维超声心动图观察心肌梗死范围及节段应变变化,分析其与冠状动脉造影检查的一致性,并与正常组心脏左室壁17节段心肌各应变对比分析。心肌梗死患者行PCI术后3个月复查梗死范围和节段应变,与术前检查结果对比分析。结果实时三维超声心动图检查示45例心肌梗死患者梗死部位和范围与冠状动脉造影检查结果一致;除前壁心尖段外,术前梗死节段心肌纵向应变、径向应变、圆周向应变和面积应变均明显低于正常组,差异均有统计学意义(均P<0.05)。PCI术后3个月复查心肌梗死范围变化,其中急性心肌梗死患者梗死范围明显变小,心肌各应变均恢复正常,左室射血分数(LVEF)>50%;亚急性心肌梗死患者梗死范围有一定缩小,对应节段各应变均有所改善,LVEF提高>5%;陈旧性心肌梗死患者梗死范围无明显缩小,对应节段各应变均无明显改善,LVEF提高<5%。结论实时三维超声心动图能较好地识别心肌梗死患者左室各节段心肌运动在空间和时间分布上的细微差别,可实时、全方位定量分析左室室壁运动状态,具有重要的临床应用价值。
Objective To evaluation of left ventricular systolic function in patients with myocardial infarction before and after coronary stent implantation by real time three-dimensional echocardiography(RT-3DE). Methods The normal values of longitudinal,radial,circumferential and area strains of 17 segments of left ventricular wall in 120 normal adults (normal group) were obtained by RT-3DE. Coronary angiography was used to determine the location and extent of infarction in 45 patients with myocardial infarction. RT-3DE was used to observe the extent of myocardial infarction and the changes of segmental strain. The consistency between the results of coronary angiography and that of myocardial strain in 17 segments of left ventricular wall in normal group was analyzed.The infarct size and segmental strain were reexamined 3 months after PCI,and the results were compared with those before PCI. Results RT-3DE showed that the location and extent of infarction in 45 patients with myocardial infarction were consistent with the results of coronary angiography. And the longitudinal strain,radial strain, circumferential strain and area strain of myocardial infarction segment were significantly lower than those of normal group(all P<0.05).Three months after PCI,the range of acute myocardial infarction was significantly reduced,myocardial strain returned to the normal range,left ventricular ejection fraction(LVEF)>50%. The range of infarction in subacute myocardial infarction was reduced to a certain extent,the strain of corresponding segments was improved and LVEF increased>5%. There was no significant reduction in the extent of the myocardial infarction,the corresponding segmental strain showed no significant improvement,and the LVEF increased<5%. Conclusion RT-3DE can better identify the slight differences in the spatial and temporal distribution of myocardial movements in each segment of the left ventricle,and the motion state of the left ventricular wall can be quantitatively analyzed in real time,which has important clinical application value.
作者
周璇奕
周前波
白建宁
范珊
李春燕
李林宏
ZHOU Xuanyi;ZHOU Qianbo;BAI Jianning;FAN Shan;LI chunyan;LI Linhong(Department of Ultrasound,People’s Hospital of Xishuangbanna,Yunnan 666100,china)
出处
《临床超声医学杂志》
CSCD
2019年第6期418-421,共4页
Journal of Clinical Ultrasound in Medicine
关键词
超声心动描记术
三维
实时
心肌梗死
应变
收缩功能
心室
左
Echocardiography,real time,three-dimensional
Myocardial infarction
Strain
Systolic function, ventricle,left
