斑点追踪成像评价急性心梗患者左心室扭转运动改变

目的 探讨二维斑点追踪成像（STI）技术评价急性心肌梗死（AMI）患者左心室心肌力学改变的临床价值。方法 采用STI测量42例AMI患者经皮冠状动脉介入术（PCI）术前、术后（72 h内）以及同期47名健康志愿者（对照组）左心室心尖旋转角度峰值、心底旋转角度峰值、扭转角度峰值、扭转速度峰值、扭转达峰时间、解旋速度峰值、等容舒张期解旋百分比的数值，分析扭转参数与常规超声心功能参数的相关性。结果 与对照组相比，AMI患者术前收缩期左心室心尖旋转角度峰值及扭转角度峰值减小、扭转及解旋速度峰值减低、收缩期达峰时间提前，等容舒张期解旋百分比减小（P均<0.01），同时心底旋转角度峰值减小（P<0.05）。对照组及AMI患者术前及术后心尖旋转角度峰值及扭转角度峰值均与射血分数（EF）明显相关（r=0.706、0.774）；心底旋转角度峰值、扭转速度峰值及达峰时间与EF无明显相关性；解旋速度峰值、等容舒张期解旋百分比与二尖瓣口舒张早期和舒张晚期血流速度比值（E/A）呈明显直线相关关系（r=0.873、0.830）。PCI术后各扭转参数均有一定程度改善，但与对照组相比差异仍有统计学意义（P均<0.05）。结论 STI能无创、准确评价AMI患者心肌扭转力学参数改变，为临床诊断、治疗及判断AMI预后提供较全面的左心室心肌功能信息；PCI术后左心室扭转运动虽可有一定程度改善，但恢复至正常仍需一段时间。

Speckle tracking imaging in estimation of left ventricular mechanics changes in patients with acute myocardial infarction

Objective To explore the value of speckle tracking imaging (STI) in estimation of left ventricular myocardiac mechanics changes in patients with acute myocardial infarction (AMI). Methods Totally 42 patients with acute myocardial infarction (AMI) before and after (in 72 h) percutaneous coronary interventions (PCI) and 47 health volunteers (control group) were analyzed using STI, the parameters included peak apical rotation (Par), peak basal rotation (Pbr), peak LV twist (Ptw), peak twist velocity (PtwV), time to peak twist (TPK), peak untwisting velocity (PutwV) and % isovolumic untwist (Iutw%). The correlation between torsional parameters and common cardiography ventricular functional parameters were also analyzed. Results Compared with control group, Par, Ptw, PtwV, PutwV and Iutw% of AMI patients all obviously decreased before PCI (all P<0.01), while Pbr decreased (P<0.05). A strong correlation was found between ejection fraction (EF) and Par, Ptw (r=0.706, 0.774), but there was no obvious relationship between Pbr, PtwV, TPK and EF. Linear correlation were found between PutwV, Iutw% and E/A (r=0.873, 0.830). All twist parameters improved in some degrees after PCI, but were still lower compared to those of control group (all P<0.05). Conclusion STI can be used to noninvasively and exactly assess left ventricular twist in patients with AMI, and provide information about left ventricular myocardiac function to help clinical diagnosis, treatment and prognosis. Left ventricular twist can be improved after PCI, but still need a long time to recover.