核素心肌显像对急性心肌梗死患者 PTCA后左心室收缩功能变化的评估价值

目的 探讨核素心肌灌注/代谢显像对急性心肌梗死（AMI）患者经皮腔内冠状动脉成形术（PTCA）后左心室收缩功能变化的评估价值。 方法 回顾性分析2015年6月至2017年12月于山西医科大学附属第一医院行PTCA治疗的AMI患者36例,其中男性27例、女性9例,年龄（57.9±12.3）岁。所有患者均在AMI发病1周内行PTCA治疗,并于治疗前3天和治疗后6~8个月行99Tcm-甲氧基异丁基异腈SPECT心肌灌注显像（MPI）和18F-氟脱氧葡萄糖PET/CT心肌代谢显像。根据治疗后左心室射血分数（LVEF）的变化值（ΔLVEF）将患者分为2组：A组为心功能改善组（ΔLVEF≥5%）;B组为心功能未改善组（ΔLVEF＜5%）。采用t检验和χ2检验分析比较2组患者的临床资料、LVEF、高峰射血率（PER）、存活心肌/坏死心肌节段数（S/N）比值及心肌肌钙蛋白I（cTnI）等指标间的差异;采用Logistic回归分析影响左心室收缩功能的相关因素;采用受试者特征工作（ROC）曲线分析预测LVEF改善（ΔLVEF≥5%）的S/N界值。 结果 （1）2组患者的性别、年龄、体重指数、吸烟史、高血压病史、糖尿病史、高脂血症病史、心绞痛病史等差异均无统计学意义（均P＞0.05）。（2）PTCA治疗前,A组和B组间LVEF、PER、cTnI的差异无统计学意义,而S/N比值（A组：1.24±1.06,B组：0.58±0.37）的差异有统计学意义（t=0.824,P=0.042）;PTCA治疗后,2组间LVEF（A组：47±12,B组：38±10）、PER（A组：2.11±0.48,B组：1.71±0.50）、S/N比值（A组：0.73±0.47,B组：0.62±0.39）的差异有统计学意义（t=−2.528、−2.366、−2.514,P=0.016、0.024、0.017）,但cTnI间的差异无统计学意义。（3）Logistic回归分析显示,S/N比值是ΔLVEF的独立影响因素（OR=2.164,P=0.018）。（4）ROC曲线结果显示,以S/N比值预测AMI患者PTCA治疗后ΔLVEF≥5%的界值为0.62,曲线下面积为0.823（95%CI：0.661~0.985）,特异度为85.71%,灵敏度为91.54%。 结论 核素心肌灌注/代谢显像对AMI患者行PTCA治疗后左心室收缩功能变化的评估具有重要的临床价值。     

Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging

Introduction

Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI.

Methods

200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events.

Results

On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B = 0.02, SE = 0.02, p < 0.001). Routine TTE had a sensitivity of 21–24% and a specificity of 95–98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ = 0.91 and κ = 0.96) compared to TTE (κ = 0.74 and κ = 0.53).

Conclusion

LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.     

MR相位对比法和形态体积分析法评价心室功能的比较研究

目的探讨相位对比法MR和形态体积分析法MR成像技术在评价心室功能中的临床应用价值。方法应用相位对比法MR(phasecontrastmagneticresonanceimaging,PCMRI)和形态体积分析法电影MRI(stereologicalcinemagneticresonanceimaging,SCMRI)分别对12例健康成年人和46例心脏病患者进行检查。首先应用SCMRI行心脏左、右室短轴电影成像,分别描记左、右室心内、外膜界面,测出左右心室舒张末期容量(EDV)、收缩末期容量(ESV)、每搏输出量(SV)、射血分数(EF)等指标;再应用PCMRI和流量分析软件分别在主动脉瓣上和肺动脉瓣上水平测得1个心动周期内的前向血流,获得SV值,并将2种方法的测量结果进行比较;同时对正常志愿者与患者组、正常志愿者组左、右两侧心室,以及PCMRI法在主动脉瓣上和肺动脉瓣上水平测得的左右心室SV均值进行比较。结果(1)PCMRI与SCMRI法所测正常志愿者左、右心室的SV相关良好,相关系数分别为090和087,2种方法测得的SV均值差异无统计学意义(P>005)。(2)患者组2种MRI测量方法所得左室SV的相关系数为085,SV均值比较差异无统计学意义(P>005),应用PCMRI法在主动脉瓣上水平测得正常人与患者组的SV均值,差异有统计学意义(P<005)。结论PCMRI与SCMRI法相比,对心室每搏输出量(SV)测量准确,相关性好,重复性高,加     

Quantitative analysis of regional left ventricular function after myocardial infarction in the pig assessed with cine magnetic resonance imaging

To assess the accuracy of quantitative analysis of global and regional wall motion and wall thickening of the left ventricle with cine magnetic resonance (MR), images obtained in eight pigs before and after myocardial infarction were compared with those obtained using gadolinium diethylenetriaminepen-taacetic acid (Gd-DTPA)-enhanced multislice spin-echo MR imaging and determination of pathology. The region with abnormal wall motion and wall thickening, as determined with cine MR imaging, identified the same region of infarction as indicated by Gd-DTPA-enhanced spin-echo MR imaging and pathology. Within the infarcted region wall motion and wall thickening analyzed with the centerline method were significantly reduced. We conclude that the use of quantitative analysis of cine MR images accurately determines localization and extent of regional left ventricular dysfunction in the infarcted heart in vivo. This analysis using dedicated software including the centerline method allows sequential assessment of regional left ventricular function in normal and infarcted hearts.     

Three-dimensional motion tracking with volumetric phase contrast MR velocity imaging

Motion tracking based on single-slice cine-phase contrast magnetic resonance imaging data has limitations. In the presence of nontrivial three-dimensional motion and deformation, volumetric data are necessary for accurate reconstruction of material point trajectories. A three-dimensional Fourier tracking method that uses volumetric data for motion tracking is presented. The method reconstructs a material point trajectory by computing its various harmonics. For any given temporal sampling rate, a frequency domain perspective of the tracking problem indicates that the method is accurate in estimating all reconstructible harmonics of a trajectory. The algorithm incorporates an intra-voxel linear spatial model into the integration to address potential tracking performance degradation due to possibly reduced spatial resolution, which may be most relevant in the slice direction (z) if the volumetric data are obtained as multiple two-dimensional slices. The tracking method was evaluated on computer-generated data sets that simulated various motion patterns. The method was also tested with two sets of in vitro data obtained using a phantom, one acquired as multiple two-dimensional slices and the other using a three-dimensional sequence capable of higher spatial resolution in the z direction. These studies demonstrated that the algorithm can achieve high sub-voxel tracking accuracy.     

急性前壁心梗经皮冠状动脉血运重建术后ST段持续抬高对心梗晚期左室功能的影响

目的　探讨急性前壁心肌梗死行直接经皮冠状动脉血运重建术 (PCI)后心电图ST段持续抬高对心梗后晚期左室功能和临床预后的影响。方法　选择因急性前壁心肌梗死入院接受急诊PCI的患者 72例 ,动态观察PCI术前后心电图ST段的变化 ,以PCI术后 1hST段下降大于 5 0 %为ST段下降组 ,相反为ST段抬高组。应用超声心动图测定心梗后早期 (2～ 3周 )和晚期 (5～ 6个月 )左室功能和室壁活动异常的变化 ,并随访其间心血管事件的发生率。结果　ST段下降组 5 3例 (74 % ) ,ST段抬高组 19例(2 6 % )。心梗后早期两组间左室功能和室壁活动异常无明显差异 ;晚期ST段抬高组LVEF明显低于ST段下降组 (P <0 .0 5 ) ,而LVEDVI、LVESVI和VWMA积分均明显高于ST段下降组 (P <0 .0 5 ,P <0 .0 1)。随访期间ST段抬高组主要心血管事件的发生率略高于ST段下降组 ,但差异无统计学意义。ST段下降组梗死前心绞痛和直接支架术的比例明显高于ST段抬高组 (P <0 .0 5 )。结论　急性前壁心肌梗死成功直接PCI后ST段持续性抬高者心梗后晚期左室功能较差。有梗死前心绞痛和直接支架术者PCI术后ST段持续性抬高的发生率可能较低     

Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction

The aim of this study was to assess global left ventricular (LV) function and regional wall motion using retrospectively ECG-gated 16-slice computed tomography (CT) in comparison with magnetic resonance imaging (MRI). Twenty-one patients (18 male, 65.5±8.6 years) with acute myocardial infarction underwent multislice spiral CT (MSCT) and MRI. From manually drawn endo- and epicardial contours, LV volumes including myocardial mass, peak filling rate (PFR), peak ejection rate (PER), time to PER (TPER) and time from end-systole to PFR (TPFR) were calculated. Regional wall motion was assessed from cine loops using a 16-segment model of the left ventricle. LV function was analyzed using the Bland–Altman method, Pearsons correlation coefficient, multivariate analysis and post hoc t tests. Regional wall motion was evaluated with weighted kappa-statistics. Multivariate analysis revealed significant differences for global LV function as determined by MSCT and MRI. Post hoc t-tests showed significant differences for end-diastolic volume (EDV), PFR and TPER (P<0.05), while there was a good agreement for the LV volumes with an ejection fraction of 46.9±8.4% for MSCT and 46.9±8.9% for MRI. PER, PFR, TPER and TPFR presented a poor correlation and a wide range of scattering between MSCT and MRI. Regional wall motion scores showed a good agreement with =0.791. Sixteen-slice spiral CT allows for reliable assessment of LV volumes, but is not yet suited for the evaluation of all functional parameters. Assessment of regional wall motion at rest is feasible.     

Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT

BACKGROUND: The actual relationship between the interval change of myocardial thallium 201 (Tl-201) radioactivity in the infarct area and the pattern of Q-wave regression is still unknown. This study was conducted to evaluate their relationship after acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 30 patients who had a first Q-wave AMI (11 without Q-wave regression and 19 with Q-wave regression) were retrospectively included. Two sets of 12-lead surface electrocardiograms and Tl-201 myocardial perfusion images were obtained 0 to 2 months and 14 to 84 months after the AMI event, respectively. The acute/subacute redistribution Tl-201 radioactivity was similar between the patients with and those without Q-wave regression. However, the patients with Q-wave regression had higher chronic redistribution Tl-201 radioactivity than those without Q-wave regression. Moreover, the patients with Q-wave regression presented a higher gradient in the redistribution Tl-201 radioactivity between the chronic and acute/subacute images than those without Q-wave regression. CONCLUSIONS: This study supports the role of functional recovery of stunning and/or hibernating myocardium in the disappearance of Q waves after AMI.     

Right ventricular function in healed myocardial infarction in man. A cineangiographic assessment

To evaluate the frequency of right ventricular dysfunction following recovery from myocardial infarction (MI) and the relationship of segmental right ventricular (RV) wall motion abnormalities to left ventricular (LV) function or location of coronary arterial stenosis, biplane right and left ventricular cineangiograms were obtained in 100 consecutive patients (4 +/- 3 months post MI). Thirty (group A) had anterior MI and significant stenosis or obstruction of left anterior descending artery (LAD). The remaining 70 patients had inferior MI. They were divided into three groups according to the site of the main coronary stenosis or obstruction and corresponding LV akinesia: right coronary artery (RCA) proximal to the acute marginal artery (RMA), (group B: 32 patients), RCA distal to the RMA (group C: 18 patients), left circumflex artery (LCF), (group D: 18 patients). RV and LV end-diastolic volume index (EDV), end-systolic volume index (ESV), stroke volume (SV) and ejection fraction (EF) have been determined. RV segmental wall motion was assessed in RAO and LAO projection by determining the percentage of systolic shortening (+ delta R) along 11 hemiaxes. Mean axial shortening (delta R) of the RV inferior and free walls were considered. When compared with that in 10 normal subjects, RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV) were increased and RV ejection fraction (RVEF) was lower in patients with anterior or inferior MI. Inferior delta R exhibited comparable sequential changes in the three groups of inferior MI and similar LVEF alteration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Microvascular obstruction and myocardial function after acute myocardial infarction: assessment by using contrast-enhanced cine MR imaging

This study was approved by the Human Investigation Committee of William Beaumont Hospital, and all patients gave informed consent. The purpose of this study was to prospectively compare contrast material-enhanced cine magnetic resonance (MR) imaging with more-standard MR imaging for the evaluation of microvascular obstruction and myocardial function in 80 patients (56 men, 24 women; mean age, 57 years; range, 29-80 years) with acute myocardial infarction after reperfusion therapy. Findings at contrast-enhanced cine MR imaging agreed with the global and transmural extent of microvascular obstruction at first-pass perfusion (intraclass correlation coefficient [IC] of 0.96 [P < .001] and 0.88 [P < .001], respectively) and inversion-recovery gradient-echo (IC of 0.90 [P < .001] and 0.93 [P < .001], respectively) MR imaging. There was no significant difference between myocardial function parameters before and after contrast material enhancement. Contrast-enhanced cine MR imaging reduced imaging time by 34% (11 of 32 minutes) and improved spatial resolution. Supplemental material: radiology.rsnajnls.org/cgi/content/full/240/2/529/DC1     

Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction

Background

Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI.

Methods

In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling.

Results

Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r = 0.74), and LD area (r = 0.72), and to a lesser extent LE area (r = 0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p < 0.05) and ejection fraction by LD enhancement ratio.

Conclusions

LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.     

Spatially resolved imaging of myocardial function with strain-encoded MR: comparison with delayed contrast-enhanced MR imaging after myocardial infarction

Strain-encoded magnetic resonance (MR) imaging was prospectively evaluated for direct imaging of systolic myocardial strain and compared with cross-registered delayed contrast material-enhanced MR imaging in five healthy volunteers and nine patients with infarction. Local contractile performance was decreased in infarcted myocardium versus that in remote and adjacent myocardium (P < .01) and in adjacent versus remote myocardium (P < .05). The extent of dysfunctional myocardium, as assessed with strain-encoded MR imaging, was greater than that of hyperenhancement, as assessed with delayed contrast-enhanced MR imaging (P < .05). Strain values obtained with strain-encoded MR imaging were strongly correlated with those obtained with three-dimensional tagged MR imaging (r = 0.75, P < .001). Strain-encoded MR imaging provides spatially resolved (1.5 x 2.5-mm) imaging and measurement of myocardial strain in humans without the need for postprocessing, which may improve routine comprehensive evaluation of myocardial viability.     

应用血流向量成像评价AMI患者PCI术前术后左室涡流变化特占

目的：应用血流向量成像（VFM）技术评价急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）术前、术后左心室收缩期涡流状态变化。方法：选择健康检查者25例（正常对照组）和AMI患者30例（AMI组）,分别对健康检查者和AMI患者PCI术前、术后1个月行超声心动图检查,采集连续三个心动周期标准三切面彩色血流动态图,分析左心室收缩期涡流横径、纵径、横向、纵向位置及最大向量速度,比较涡流在正常对照组、AMI组术前、术后的变化并进行统计学分析。结果：与正常对照组相比,AMI组术前左心室收缩早期涡流纵径增大[分别为（27．08±4．37）和（21．64±5．41）min,P〈0．05],最大向量速度减小[分别为（25．23±8．42）和（32．83±12．23）cm／s,P〈0．05]。术后1个月AMI组涡流流量、强度、最大向量速度较术前增加（P〈0．05）。结论：健康成人左心室收缩期涡流遵循一定的规律,AMI患者左室收缩期涡流不规则,导致能量的损耗,PCI术后患者的涡流状态有所改善。VFM技术为评价急性心肌梗死患者及PCI术前、术后心腔内血流变化提供了一种新途径。     

应变率成像对急性前壁心肌梗死患者左心功能的评价

目的:观察急性前壁心肌梗死患者心肌应变率(SR)的变化特点,探讨应变率成像(SRI)技术定量评价急性心肌梗死(AMI)患者的左室局部心肌功的临床应用价值。方法:应用SRI对20例AMI患者和30例正常人左室各室壁节段纵向收缩期、舒张早期及房缩期的峰值应变率进行测定,并以冠脉造影结果为标准进行对比分析。结果:SRS:AMI组基底部、中部水平所有室壁较正常对照组显著性减低,心尖水平除下壁外其他室壁较对照组显著性减低;SRE:AMI组不同水平左室所有室壁较对照组显著性减低;SRA:基底部前间隔、后壁、前壁、下壁较对照组显著性减低,中部后间隔、后壁、前壁较对照组显著性减低,心尖水平后间隔、前壁、下壁AMI组较对照组显著性减低(P<0.01和0.05)。结论:SRI技术是临床无创、定量评价急性心肌梗死局部心肌功能的有效方法。     

Myocardial velocity gradient imaging by phase contrast MRI with application to regional function in myocardial ischemia

Velocity-encoded phase contrast magnetic resonance imaging (MRI) has the potential to quantify regional myocardial contractile function with a sensitivity to motion comparable to implanted ultrasonic crystals. An MRI sequence and post-processing algorithm were developed to measure myocardial velocity gradients on a 1.5 T MRI scanner. These methods were validated on a rotating phantom and applied to dogs before (n = 11) and during prolonged coronary occlusion (n = 5). In phantom validation studies, the average absolute error corresponded to motion equivalent to 0.03 ± 0.04 mm (mean ± SD) during the repetition time of the experiment. Rigid body corrections during post-processing significantly simplified the interpretation of myocardial velocity vectors. In vivo, rigid body motion contributes substantially to the recorded myocardial velocities in systole and diastole and can give the false impression of regional wall motion abnormalities. After rigid body correction, normal systolic and diastolic velocity vectors in short-axis views of the left ventricle were primarily directed toward the center of the left ventricle. Transmural radial strain rate was 2.0 ± 0.6 sec⁻¹ during systole and −3.6 ± 1.1 sec⁻¹ during early diastole in normal canine hearts. Ischemic myocardium was easily discriminated from normal left ventricle by velocity-encoded phase contrast MRI both qualitatively and quantitatively (P < 0.01 in systole and P < 0.05 in early diastole). Although the myocardial velocity images have a spatial resolution on the order of a millimeter, the velocity encoding describes the mechanical consequences of focal myocardial ischemia with sensitivity to submillimeter displacement of the pixels. The three-dimensional nature of velocity-encoded MRI is particularly well suited to the study of the complex motion of the heart in vivo. Magn Reson Med 42:98–109, 1999. © 1999 Wiley-Liss, Inc.     

Evolutionary changes in left and right ventricular function in acute myocardial infarction

To determine the evolutionary changes in right and left ventricular function in acute myocardial infarction, 3 serial gated blood pool scans were performed in 76 patients within 24 hours (24 H), at 10 days (10 D) and 3 months (3 M) following the onset of myocardial infarction. The patients were divided into 3 groups: ANT (anterior MI), INF (inferior MI without right ventricular dysfunction) and RVF (inferior MI with right ventricular dysfunction). LVEF in ANT was significantly lower than that of INF and RVF at 24 H, 10 D and 3 M. The ratio of right ventricular volume to LV volume (RVV/LVV) was compared among 3 groups. The mean values of RVV/LVV in RVF were 1.3 through 24 H and 3 M and they were significantly higher than the other two groups. The RVV/LVV in ANT and INF were around 1.0. LVEDVI in RVF was rather smaller than that of ANT and INF. LVESVI in ANT at 24 H was significantly larger than that of INF and RVF and the mean value of LVESVI in ANT were around 60 ml/M2 from 24 H to 3 M. LVEF in ANT, RVF and INF did not increase significantly during peak exercise at 3 M. However, quantitative regional wall motion analysis revealed that regional wall motion of R2 (posterolateral wall motion) in ANT and R5 (septal wall motion) in INF decreased significantly during peak exercise. These impairments in regional wall motion might be due to the exacerbation of ischemia of non-infarcted area.     

Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function

Purpose

Exercise training might exert its beneficial effects on myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. We evaluated whether long-term exercise-based cardiac rehabilitation started early after ST-elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function.

Methods

Forty-six patients with recent STEMI and residual inducible hypoperfusion were randomized into two groups: 25 enrolled in a 6-month outpatient exercise-based cardiac rehabilitation programme (group T) and 21 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and dipyridamole rest gated myocardial perfusion single photon emission computed tomography within 1 week after STEMI and at 6-month follow-up.

Results

At follow-up, group T showed an improvement in peak oxygen consumption, oxygen pulse and in the slope of increase in ventilation over carbon dioxide output (all p?<?0.01) associated with a reduction of stress-induced hypoperfusion (p?<?0.01) and an improvement in resting and post-stress wall motion score indexes (both p?<?0.01), resting and post-stress wall thickening score indexes (both p?<?0.05) and resting and post-stress LV ejection fraction (both p?<?0.05). On the contrary, no changes in cardiopulmonary indexes, myocardial perfusion and LV function parameters were observed in group C at follow-up.

Conclusion

Exercise training started early after STEMI reduces stress-induced hypoperfusion and improves LV function and contractility. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with an improvement of cardiovascular functional capacity.     

Tei指数检测对心肌梗死患者择期经皮冠状动脉介入治疗后左心功能评价

目的 :检测Tei指数及常规超声心动图左心室射血分数 (leftventricularejectionfraction ,LVEF)评价急性心肌梗死患者择期冠状动脉介入治疗 (percutaneouscoronaryintervention ,PCI)对心功能的影响 ,同时对两种指标进行对比。方法 :选择接受择期PCI的 30例急性心肌梗死患者 ,在术前及术后检测左心室Tei指数及常规超声心动图LVEF。结果 :PCI后Tei指数LVEF均有改善 ,Tei指数较LVEF敏感性更高 ,两者相关性良好。结论 :Tei指数是评价急性心肌梗死患者择期PCI后左心功能的敏感指标。     

组织多普勒技术定量评价陈旧性室间隔心肌梗死的右室功能

目的:采用不同组织多普勒技术定量研究陈旧性室间隔心肌梗死患者的右室局部和整体功能。方法:20例陈旧性室间隔心肌梗死患者,30例健康成人。采用应变率及组织速度成像获取右室侧壁各节段的组织速度、位移、应变及应变率曲线。测量收缩功能参数:收缩期峰值速度(Vs)、最大位移(D)、收缩期峰值应变(S)及应变率(SR);测量舒张功能参数:舒张早期充盈速度(Ve)、心房收缩期充盈速度(Va)、舒张早期充盈应变率(Esr)、心房收缩期充盈应变率(Asr)。脉冲组织多普勒获取三尖瓣环运动频谱曲线,计算右室Tei指数。结果:陈旧性室间隔心肌梗死组右室侧壁基底段的S和D以及心尖段的SR和D均较正常组明显减低;基底段及中间段的Ve和Esr均较正常组明显减低;右室Tei指数明显高于正常组。结论:陈旧性室间隔心肌梗死患者右室侧壁多个节段的局部收缩和舒张功能明显受损,此外右室整体功能也明显受损。