心肌梗死患者左心室局域舒张功能的应变成像

目的探索冠心病患者左心室舒张各期局部心肌应变成像特点及其在评价左心室局域舒张功能的可能性。方法对54例前壁心肌梗死患者(MI组)和78名正常对照组(NOR组)左室心肌进行组织多普勒成像检查。记录心尖二腔动态图像,应用应变成像描记技术获取左心室各阶段心肌同步应变成像,测量等容舒张期(IR)、快速充盈期(RF)、缓慢充盈期(SF)、心房收缩期(AC)局部心肌应变值变化幅度,对两组结果进行对比分析。结果在NOR组舒张各期,66/78(85%)例的应变值(S)按前壁心尖、心底、中部的顺序,呈负值增大的梯度变化;MI组符合这一规律仅占9/54(17%)例。IR期:NOR组564/624(90.4%)节段为向上波段且走行较一致;MI组向上波段有123/432(28.5%)节段,且各节段波走行不一致,两组相比,P<0.05。RF期:NOR组为快速向上波段(576/624节段,92.3%);MI组向上波段少(102/432节段,23.6%),两组相比P<0.01。SF期:与NOR组多为水平节段相比,MI组在缺血节段多为向上波段,P<0.05。结论局部心肌缺血梗死导致主动舒张期的局部心肌应变成像显著异常。应变成像能敏感、直观、无创地定量评价局域舒张功能。

Evaluation of regional left ventricular diastolic function in patients with myocardial infarction by strain imaging

Objective To explore the strain features of regional wall abnormalities in patients with coronary artery disease during each diastolic period,and its possibility to evaluate regional left ventricular diastolic function.Methods Fifty-four with anterior myocardial infarction(MI group) and 78 normal subjects(NOR group) underwent Doppler tissue imaging,which were performed in 2-chamber-view by strain curves synchronously.Results In NOR group,S value of 66/78(84.62%) cases showed a gradually increasing negative value from the apex to base to middle of left ventricle,while in MI group,there were 9/54(16.67%) cases with such a trend.IR phase: in NOR,564/624(90.38%) segments were upward wave bands,but in MI group,there were 123/432(28.47%) segments having such waves.(P<0.05) RF phase: In NOR group,576/624(92.31%) segments were upward and steep wave bands,but in MI group,the number of upward waves was obviously less(102/432 segments,23.61%)(P<0.01).SF period: Compared with NOR group,which was horizontal,MI group had upward wave bands(P<0.05).Conclusion Regional myocardial ischemia and infarction can cause significant regional diastolic wall abnormalities of strain value in active diastolic phase.Regional diastolic wall motion abnormalities can be evaluated quantitatively and synchronously with high sensitivity by SC which has the potential value in diastolic function.