左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构

目的 探讨应用二维斑点追踪(STE)技术预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的价值。方法 对75例AMI患者于PCI术后72 h及6个月行STE检查,测算左心室整体圆周应变(GCS)及整体纵向应变(GLS)。以术后6个月左心室舒张末期容积(LVEDV)≥15%作为LVR诊断标准。进行统计学分析。结果 PCI术后6个月,75例中56例未发生重构(非重构组),19例发生LVR(重构组),发生率25.33%(19/75)。与术后72 h比较,重构组术后6个月LVEF减低,非重构组术后6个月LVEF增高(P均<0.05)。与非重构组比较,重构组术后72 h及术后6个月GCS及GLS均减低(P均<0.05)。LVEF、GCS及GLS均与LVR呈负相关(r=-0.39、-0.52、-0.64,P均<0.01)。GLS及GCS是LVR的独立预测因子。GLS的ROC曲线下面积最大,预测LVR的阈值为-12.45%,敏感度和特异度分别为86.3%及87.2%。STE参数测量观察者间差异为(9.32±3.14)%,观察者内差异为(7.18±2.26)%。结论 通过STE测得的GLS可用以准确预测AMI患者PCI术后LVR。

Left ventricular global longitudinal systolic strain in predicting left ventricular remodeling of acute myocardial infarction patients after percutaneous coronary intervention

Objective To evaluate left ventricular global functions measured by speckle tracking echocardiography(STE) in predicting left ventricular remodeling(LVR) of acute myocardial infarction(AMI) patients after percutaneous coronary intervention(PCI). Methods STE examinations were performed on 75 patients with AMI. And global left ventricular longitudinal systolic strain(GLS) and circumferential strain(GCS) were measured within 72 hours and 6 months after PCI. An increase of more than or equal to 15% in left ventricular end diastolic volume after 6 months was the standard for LVR diagnosis. Statistic analysis was performed. Results There were 19 patients with LVR(LVR group) and 56 patients without LVR(non-LVR group). The incidence of LVR after 6 months was 25.33%(19/75). Compared with 72 h after PCI, the LVEF of 6 monthes after PCI in LVR group decreased, while that in non-LVR group increased(both P<0.05). Compared with non-LVR group, GCS and GLS decreased in LVR group 72 h and 6 months after PCI(all P<0.05). LVEF, GCS and GLS were negatively correlated to LVR(r=-0.39,-0.52,-0.64, all P<0.01). GLS and GCS were the independent predictors of LVR. The area under the curve(AUC) of GLS was the largest. The optimal GLS cut-off for predicting adverse LVR was-12.45% with sensitivity of 86.3% and specificity of 87.2%. The inter-and intra-observer variability of STE parameters was(9.32±3.14)% and(7.18±2.26)%, respectively. Conclusion GLS evaluated by STE can be used to predict the LVR in AMI patients after PCI.