斑点追踪成像评价冠心病患者CABG或PCI术治疗前后左室收缩功能

目的 应用斑点追踪成像技术( speckle tracking imaging,STI)评价冠心病患者行冠脉内支架置入术(percutaneous coronary intervention,PCI)或冠脉搭桥术(coronary artery by pass grafting,CABG)前后不同阶段左心室的局部和整体收缩功能.方法 选取新桥医院心内科2010年11月至2011年10月期间行PCI术治疗的冠心病患者35例(男性21例,女性14例),年龄(56.1±12.5)岁,选取本院心外科同期行CABG手术治疗的冠心病患者30例(男性19例,女性11例),年龄(57.8±14.8)岁,分别于手术前3d、术后1、3、6个月时行超声心动图检查,采集相应时间点的左心室二维图像;另选年龄性别相匹配的48名健康者作为正常对照组;比较分析其常规超声心动图参数、二维应变参数的变化差异,以及各组在各时间点内的相关性.结果 ①冠心病PCI组及CABG组术前常规心脏超声参数(E/A、LVEF)STI,参数(GBLS、GBRS、GBCS、Prot apex、Prot base、Ptw)均显著低于正常对照组(P＜0.05).②冠心病PCI组术后1、3、6个月各阶段的参数值均较术前增高且呈递增趋势,但仍低于正常对照组(P＜0.05);术后各阶段参数值与术前比较差异显著(P＜0.05).③冠心病CABG组术后3、6个月STI参数与正常组比较,差异有统计学意义(P＜0.05),但术后1个月测值较术前比较无明显改善(P＞0.05).④PCI及CABG组的GBLS、GBRS、GBCS均与LVEF显著性相关(P＜0.01).结论 STI可以定量评价冠心病患者行PCI或CABG手术治疗前后左室局部及整体收缩功能,对评价治疗效果及预后具有重要的临床价值.

Assessment of left ventricular systolic function in patients with coronary heart disease before and after PCI or CABG with speckle tracking imaging

Objective To assess the regional and global systolic function of left ventricle before and after PCI or CABG with speckle tracking imaging(STI).Methods Thirty-five patients with coronary heart disease(21 males and 14 females with an average age of 56.1±12.5 years) and 30 patients with coronary heart disease(19 males and 11 females with an average age of 57.8±14.8 years) admitted to our hospital from November 2010 to October 2011 for PCI and CABG,respectively,were enrolled in this study.They underwent echocardiography 3 d before operation and 1,3,6 months after operation.Their left ventricular 2D strain data were collected at the corresponding time points.Forty-eight age-and gender-matched healthy subjects served as a control group.Parameters of routine echocardiography and 2D strain obtained at different time points and their correlation were compared and analyzed.Results The parameters of preoperative routine echocardiography,E/A,GBLS,GBRS,GBCS,Prot apex,Prot base,and Ptw,were significantly lower in PCI group and CABG group than in control group(P<0.05)and significantly higher in PCI group 1,3,and 6 months after operation than in control group(P<0.05).However,no significant difference was found in these parameters 1 month after CABG operation and before operation(P>0.05).The GBLS,GBRS,and GBCS were significantly correlated with the systolic function of left ventricle in PCI and CABG groups(P<0.01).Conclusion STI can be used to assess the regional and global systolic function of left ventricle in patients with coronary heart disease before and after PCI or CABG,and is of important value for the treatment and prognosis of such patients.