实时三维超声成像及斑点追踪评价冠状动脉再通术前后左心室功能变化

目的 探讨实时三维超声成像（real-time three-dimensional echocardiography,RT3DE）及二维斑点追踪显像（two dimensional speckle tracking imaging,2DSTI）评价冠状动脉慢性完全闭塞（coronary artery chronic total occlusions,CA CTOs）患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术前后的左心室功能变化情况.方法 选择2012年1月-2013年12月在辽宁医学院附属第一医院收治的40例CA CTOs患者,分别于术前及术后1个月接受标准超声心动图检查,应用RT3DE和2DSTI对左心室射血分数（left ventricular ejection fraction,LVEF）、左心室舒张末期容积（left ventricular end-diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、收缩不同步指数（systolic dyssynchrony index,SDI）及左心室整体纵向应变（left ventricular global longitudinal strain,LVGLS）进行测量分析,并与30例健康志愿者进行比较.结果 与PCI术前比较,术后1个月LVEF显著增加（P＜0.05）,LVEDV和LVESV显著下降（P均＜0.05）,SDI也显著下降（P＜0.05）,LVGLS显著增加（P＜0.05）;与对照组比较,各参数指标仍未达到正常水平（P＜0.05）.LVGLS的增加与LVEF增加呈正相关（r=0.27,P=0.02）.结论 RT3DE的LVEDV、LVESV、SDI及2DSTI的LVGLS能较好地评价CA CTOs患者PCI术后左心室功能的恢复情况,提示左心室功能明显改善.

Evaluation of RT3DE and 2DSTI on the changes in left ventricular function after percutaneous coronary intervention of coronary artery chronic total occlusions

Objective To detect the changes of left ventricular functions in patients with coronary artery chronic total occlusions （CA CTOs） before and after PCI using two dimensional speckle tracking imaging （2DSTI） and real-time three dimensional echocardiography （RT3DE）. Methods Fifty patients with CA CTOs admitted to the First Affiliated Hospital of Liaoning Medical College were enrolled in our study. All included patients and 30 normal controls underwent standard echocardiography with RT3DE and 2DSTI to assess the left ventricnlar ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, systolic dyssynchrony index （SD1） and left ventricular global longitudinal strain （LVGLS） before operation and 1 month after operation. Results One month after PCI, LVEF and LVGLS significantly increased （P 〈 0.05）, while LVEDV, LVESV and SDI significantly decreased （P 〈 0.05）. However, compared with the control group, each parameter index still did not up to the normal standard （P 〈 0.05）. The increase of LVGLS and LVEF showed positive correlation （r=27, P=0.02）. Conclusion LVEF, LVEDV, LVESV, SDI derived from RT3DE and LVGLS derived from 2DSTI can evaluate the recovery of the left ventricular function in CA CTOs patients effectively after PCI, which suggests significant improvement of left ventricular function.