二维纵向应变评价急性心肌梗死患者入院至介入治疗时间与左心室功能改善的相关性研究

目的 应用二维斑点追踪显像技术( STI)评价急性心肌梗死(AMI)患者入院至进行经皮冠状动脉介入术(PCI)治疗的时间与左室(LV)功能改善的关系,探讨STI的临床应用价值.方法 采集61例经PCI治疗的首发AMI患者PCI术前、术后7d及术后30 d时的左室图像并准确记录入院至PCI治疗的时间,分析得出左室峰值纵向应变(LPSS),以术后30 d较术前左室射血分数(LVEF)改善(ΔLVEF)≥5％分为心功能改善组和非改善组.结果 与非改善组相比,改善组的入院至PCI治疗的时间明显缩短(P ＜0.001),术后7d梗死节段LPSS(P＜0.005)、术后30 d LVEF(P＜0.001)、整体LPSS(P＜0.001)和梗死节段LPSS( P＜0.001)明显增高;PCI术后7d梗死节段LPSS与入院至PCI治疗时间存在相关性(r =0.290,P＜0.05),术后30 d的LVEF(r=0.303,P＜0.05)和整体LPSS(r=0.300,P＜0.05)与入院至PCI治疗时间存在相关性,梗死节段LPSS与入院至PCI治疗时间相关性更高(r=0.590,P＜0.001).结论 与LVEF和整体LPSS相比,梗死节段LPSS能更好地预测左室功能的早期改善,是临床上评价入院至PCI治疗时间对AMI患者左室功能早期影响的有效指标.

Assessment of the correlation between time during admission to percutaneous coronary intervention and left ventricular function recovery of acute myocardial infarction by two-dimensional speckle tracking imaging

Objective To assess the correlation between time during admission to percutaneous coronary intervention (PCI) and left ventricular function recovery of acute myocardial infarction (AMI) by two-dimensional speckle tracking imaging (STI).The clinical value of STI in assessing therapeutic effect of AMI treated by PCI and estimation of the prognosis were discussed.Methods Sixty-one AMI patients who had AMI for the first time and had been treated by primary PCI were enrolled.Dynamic images were acquired before PCI,at 7 days after PCI and 30 days after PCI and analyzed by STI.The time during admission to PCI of AMI patients was recorded accurately.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS) values (global,infarcted area) by STI.According to the comparison of left ventricular ejection fraction(LVEF) before PCI and 30 days after PCI,patients were divided into left ventricular function improved group (ΔLVEF≥5 ％) and not-improved group,and the values of LPSS and time during admission to PCI were compared between the two group respectively.Results Compared to not-improved group,the time during admission to PCI in improved group was lower ( P ＜0.001),infarcted segmental LPSS at 7 days after PCI ( P ＜0.05) and both global ( P ＜0.001) and infarcted segmental LPSS ( P ＜0.001) at 30 days after PCI in improved group were higher than those in not-improved group.Linear regression analysis showed that both global and infarcted segmental LPSS were significant correlated to LVEF respectively ( P ＜0.001,all).Infarcted segmental LPSS at 7 days after PCI were correlated to the time during admission to PCI ( P ＜0.05).LVEF ( r =0.303,P ＜0.05),global ( r =0.300,P ＜0.05)and infarcted segmental LPSS ( r =0.590,P ＜0.001) at 30 days after PCI were correlated to the time during admission to PCI.Conclusions STI provides reliable and useful clinical information for the assessment of therapeutic effect of AMI treated by PCI and estimation of the prognosis by sensitively presenting the close correlation between time during admission to PCI and left ventricular function recovery of AMI patients.