三维超声心动图评价冠心病PCI术后左心室收缩功能变化的研究

目的评价三维超声心动图技术定量分析存在节段性室壁运动异常的冠状动脉粥样硬化性心脏病（冠心病）患者左心室局部收缩功能的可行性和可靠性。方法对60例有明显节段性室壁运动异常的冠心病患者进行PCI手术,对手术前后的左心室功能指标进行左心室三维超声心动图检查,并对术前术后的测量值进行对比分析。结果二维超声心动图与三维超声心动图比较低估左心室收缩末容量（ESV）及舒张末容量（EDV）,高估左心室射血分数（LVEF）。对60例冠心病患者PCI术前、术后进行的各参数的测量和比较,结果显示：PCI术后1个月左心室局部收缩末期容量（RESV）、左心室局部舒张末期容量（REDV）降低,左心室局部射血分数（REF）、左心室整体射血分数（EF）、左心室局部心搏量（RSV）明显升高（P〈0.05）。这反映了PCI术后左心室局部心肌的收缩能力和射血能力较术前增强。PCI术后左心室各节段REF测量值均显著高于术前（P〈0.05）。结论实时三维超声心动图定量评价冠心病节段性室壁运动异常,左心室17节段局部收缩功能具有高度的可行性和可靠性;PCI术前、术后左心室各节段局部收缩功能存在差异性;冠心病患者PCI术后室壁运动减弱节段的局部收缩功能显著增强。

Study on the change of left ventricle systolic function of the patients with coronary heart disease evaluated by 3-dimensional echocardiography before and after PCI

Objective To evaluate the feasibility of 3-dimensional echocardiography（3DE） in evaluating left ventricle systolic function of the patients with coronary heart disease who have regional wall motion abnormality（RWMA）.Methods Before and after PCI,60 patients with coronary heart disease who had RWMA were examined by 3DE.The quantitive analysis for the 3DE images was performed by software,and global and 17 regional LV volume-time curves were drawn.Then,regional left ventricle end-diastolic volume（LVREDV）,left ventricle regional end-systolic volume（LVRESV）,left ventricle regional stroke volume（LVRSV） and left ventricle regional ejection fraction（LVREF） were detected and analyzed for both groups.Results The 2-Dimensional echocardiography （2DE） underestimated the values of EDV,ESV,however,which overestimated EF,as compared with the parameters got by 3DE.On one month after PCI operation,the values of REF,EF and RSV were increased,however,the values of REDV,RESV were decreased significantly（P 0.05）,which indicated that the regional contractility and ejection of left ventricle were strengthened.The REF values after PCI were significantly higher than those of control group（P0.05）.Conclusion （1）It is highly feasible and credible to quantitively evaluate the regional left ventricle myocardial contraction in patients with coronary artery disease complicated with regional wall motion abnormality by 3DE.（2） The regional left ventricle systolic function has heterogeneity before and after PCI.（3）The left ventricle regional systolic function of hypokinetic segments in patients with coronary heart disease after PCI is significantly increased.