摘要
目的探讨二维斑点追踪(2D-STE)在评估急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左室收缩功能和预后中的价值。方法选取接受急诊PCI治疗的AMI患者84例,于PCI术后3 d、1个月、3个月、6个月行2D-STE检查,比较手术前后常规超声心动图检查参数,以及心肌纵向应变(LS)、径向应变(RS)及圆周应变(CS)的差异;分析各应变差值(ΔLS、ΔRS、ΔCS)与左室射血分数(LVEF)的相关性。根据是否发生预后不良事件将84例患者分为预后良好组51例和预后不良组33例,比较两组临床及超声检查资料,应用多因素Logistic回归分析影响预后的不良因素。绘制受试者工作特征(ROC)曲线分析LS、RS、CS对AMI不良预后的诊断效能。结果AMI患者PCI术后1个月、3个月、6个月左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)均低于术后3 d(均P<0.05),且术后3个月、6个月LVEDV和LVESV均低于术后1个月(均P<0.05)。LVEF在PCI术后各时间点逐渐升高(P<0.05);AMI患者LS、RS、CS在PCI术后各时间点均逐渐升高(均P<0.05)。AMI患者术后3 d、1个月、3个月、6个月各应变参数差值ΔLS、ΔRS、ΔCS与LVEF均呈正相关(均P<0.05)。预后良好组与预后不良组冠状动脉病变范围、LVEDV、LVESV、LVEF、LS、RS、CS比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,冠状动脉病变范围、LVEF、LS、RS、CS均是AMI患者不良预后的独立影响因素(均P<0.05);LS、RS、CS评估AMI患者不良预后的曲线下面积分别为0.746(95%CI:0.642~0.851)、0.691(95%CI:0.578~0.804)、0.729(95%CI:0.621~0.839)。结论2D-STE可客观反映AMI患者PCI术后左室收缩功能的变化,能为AMI患者预后评估提供重要依据。
Objective To explore the value of two-dimensional speckle tracking echocardiography(2D-STE)in evaluating left ventricular systolic function and prognosis after percutaneous coronary intervention(PCI)for acute myocardial infarction(AMI).Methods A total of 84 patients with AMI who underwent emergency PCI in our hospital were selected.2DSTE was performed 3 d,1 month,3 months and 6 months after surgery,the parameters of conventional echocardiography,the longitudinal strain(LS),radial strain(RS),and circumferential strain(CS)of the myocardium were recorded.The correlation between D-value of strain(ΔLS,ΔRS,ΔCS)and ejection fraction(LVEF)were analyzed.According to the occurrence of adverse prognostic events,84 patients were divided into good prognosis group(n=51)and poor prognosis group(n=33).The clinical and ultrasonic examination results of two groups were compared,the multivariate Logistic regression analysis was used to analyze the adverse prognostic factors.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of LS,RS,CS on the prognosis of AMI.Results The left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)of AMI patients at 1 month,3 months and 6 months after PCI were lower than those of postoperative 3 d(all P<0.05),and LVEDV and LVESV at 3 months and 6 months after PCI were lower than those at 1 month after PCI(all P<0.05).LVEF increased gradually at different time points after PCI(all P<0.05).The LS,RS and CS were increased gradually at different time points after PCI in AMI patients,the difference were statistically significant(all P<0.05).TheΔLS,ΔRS,ΔCS in AMI patients at 3 d,1 month,3 months,and 6 months after PCT were positively correlated with LVEF(all P<0.05).There were statistically significant differences between the good prognosis group and the poor prognosis group in the range of coronary lesions,LVEDV,LVESV,LVEF,LS,RS,CS(all P<0.05).Multivariate Logistic regression analysis showed that the range of coronary lesions,LVEF,LS,RS and CS were all independent factors affecting the prognosis of patients(all P<0.05).Area under the curve for AMI prognosis assessed by LS,RS,and CS were 0.746(95%CI:0.642~0.851),0.691(95%CI:0.578~0.804),0.729(95%CI:0.621~0.839),respectively.Conclusion 2D-STE can objectively reflect the changes of left ventricular systolic function in patients with AMI after PCI,and can provide an important basis for patient prognosis evaluation,which has good clinical application value.
作者
陈媚聪
马静丽
陈文忠
黄灿辉
尚利
CHEN Meicong;MA Jingli;CHEN Wenzhong;HUANG Canhui;SHANG Li(Department of Ultrasound,Guangzhou First People’s Hospital,Guangzhou 510000,China)
出处
《临床超声医学杂志》
CSCD
2020年第9期675-679,共5页
Journal of Clinical Ultrasound in Medicine
关键词
斑点追踪
二维
心肌梗死
急性
冠状动脉介入术
经皮
收缩功能
心室
左
Speckle tracking echocardiography,two-dimensional
Myocardial infarction,acute
Coronary intervention,percutaneous
Systolic function,ventricle,left
