急性心肌梗死患者组织多普勒的变化特征

目的 探讨急性心肌梗死(AMI)患者的组织多普勒变化特征.方法 以31例首次发病的AMI患者为研究对象,在发病24h内获取其标准心尖二腔、长轴、四腔二维彩色组织多普勒图像,描记心肌各节段的组织速度图(TVI)、组织位移(TT)曲线,测量基底段、中段收缩相峰值,并与40例正常人对照分析.结果 前壁AMI患者的收缩期心肌运动速度峰值(Sm)和组织位移峰值(D)与正常人比较,梗死相关动脉(IRA)非完全闭塞组前壁中段和前间隔基底段、中段D下降有显著性差异(P＜0.001或P＜0.01);IRA完全闭塞组连同前壁基底段Sm和D减低均有显著性差异(P＜0.001或P＜0.01),峰值低于非完全闭塞;下壁AMI患者只有完全闭塞时下壁基底段和侧壁中段表现出减低有显著性差异(P＜0.001或P＜0.01、P＜0.05).AMI患者非梗死相关动脉(NIRA)的Sm和D与正常人比较,前壁AMI所有侧壁、下壁、后壁和室间隔基底段、中段的Sm和D减低均有显著性差异(P＜0.001),下壁AMI只在后壁、侧壁部分节段减低有显著性差异(P＜0.01).结论 前壁AMI患者的Sm和D与正常人比较能够在急性缺血早期无创、定量、准确、敏感地区分正常及缺血、坏死心肌病变程度加重,敏感性增加.在下壁AMI患者的Sm和D的差异不显著.

The feature of tissue Doppler imaging in patients with acute myocardial infarction

Objective This study was designed to measure the peak value of velocity(Sm)and displacement(D) of patients with anterior or inferior Acute myocardial infarction(AMI) during ejection period; And to observe the changes of Sm and D in segments of the infarct-related artery in different degree of stenosis (complete occlusion or not); In the meanwhile, to investigate the difference of anterior AMI and inferior AMI in Sm or D in segments of the non infarct-related artery. Methods The study population included 42 healthy volunteers and 31 patients with AMI. All patients with heart attack were imaged within 24-hours.and 2D tissue Doppler imaging(TDI) was acquired in all patients. The peak value of Sm and D was compared with control group. Results Sm and D of patients with anterior AMI was lower than that of the control group(P<0.001 or P<0.01 ), when IRA was not completely occluded, they were also decreased significantly(P<0.001 or P<0.01) in the base and middle of anterior septal or mid-anterior wall in infracted regions. When IRA was completely occluded in all infracted regions in anterior septal and anterior wall , the changes of the value were lower than that of the complete occlusion. Sm and D of patients with inferior AMI were significantly decreased compared to controls(P<0.001 or P<0.01?P<0.05)only when IRA was completely occluded in the base of inferior wall and middle of lateral wall. Sm and D of patients with AMI were compared to controls in non-infracted regions in lateral wall, posterior wall, ventricular septum and inferior wall, all of them decreased significantly(P<0.001)in anterior AMI, only part regions of lateral wall and posterior wall decreased significantly(P<0.01)in inferior AMI. Conclusions the peak value of velocity and displacement of patients with anterior AMI appear useful and sensitive for evaluating acute ischemic myocardium or necrosis myocardium, especially when IRA is completely occluded, Sm and D is a noninvasive, rapid, accurate and quantitative method that can be measured at bedside to assess anterior AMI.