三维斑点追踪技术用于急性冠状动脉综合征PCI术后的评价

目的应用三维斑点追踪技术(3D-STE)评价急性冠状动脉综合征(ACS)病人接受经皮冠状动脉介入(PCI)术后左心功能的变化。方法以2014年3月—2015年3月接受PCI治疗的83例ACS病人为观察对象,病人于PCI治疗前,治疗后7 d、30 d、90 d、180 d进行超声检查评价病人的左心功能,采用常规超声心动图检查心率、左心房前后径、左心室前后径、室间隔厚度,3D-STE检测左心室整体纵向收缩期峰值应变(LVGLS)、左心室整体环向收缩期峰值应变(LVGCS)、左心室整体径向收缩期峰值应变(LVGRS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF),以同期在院门诊进行健康查体的正常人60例为对照。采用重复测量的方差分析以及LSD-t法,比较病人心脏功能在各个时间节点与正常人的不同。结果观察组病人心率、左房前后径、左室前后径数据在PCI治疗前,治疗后7 d、30 d、90 d,均明显高于对照组人群(均P0.05);接受PCI治疗后,心率、左心房前后径、左心室前后径均逐渐降低,至PCI治疗后90 d下降至最低点(P0.05),接近并达到对照组水平。随着时间节点向后延伸(PCI治疗前、治疗后7 d、30 d、90 d、180 d),LVGLS、LVGCS、LVGRS、LVEF逐渐升高,LVEDV、LVESV逐渐降低(均P0.05),在PCI治疗后180 d时达到随访的高点;同对照组人群比较,不同时间节点LVGLS、LVGCS、LVGRS、LVEF均明显低于对照组,LVEDV、LVESV则明显高于对照组(P0.05)。结论ACS病人的左心功能明显低于正常人,接受PCI治疗后呈上升趋势,但仍未达到正常人水平。三维斑点追踪技术可以定量、无创地用于评价ACS病人PCI术后左心室功能的变化。

Three dimensional speckle tracking technique in the evaluation of acute coronary syndrome patients after percutaneous coronary intervention

Objective To evaluate the changes of left ventricular function in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) treatment by using three-dimensional speckle tracking echocardiography ( 3D-STE ) technique . Methods Eighty-three patients with ACS treated by PCI from March 2014 to March 2015 underwent ultrasound echocardiography diagram with and without 3D-STE before and 7, 30, 90, and 180 days after PCI treatment. We used conventional ultrasound echocardiography diagram to evaluate patient’s heart rate and left atrial diameter, left ventricular diameter, and thickness of interventricular septum; and used 3D-STE to evaluate the left ventricular global longitudinal peak systolic strain (LVGLS), left ventricular global circular peak systolic strain (LVGCS), left ventricular global radial peak systolic strain (LVGRS), left ventricular end diastolic volume (LVEDV), left ventricular end systolic diastolic volume (LVESV), and left ventricular ejection fraction (LVEF). Sixty cases of healthy subjects were selected as the control group. By using repeated measures analysis of variance and LSD Post-hoc comparisons we compared the heart function among different time points of exams in patients and between patients and controls. Results The heart rate, left atrial diameter, and left ventricular diameter before and 7,30,90 days after PCI treatment were significantly higher in the patient group than the control group (P<0.05). After PCI treatment, the patient’s heart rate, left atrial diameter, left ventricular anterior and posterior diameter gradually dropped to the lowest point at 90 days after PCI treatment (P<0.05). The LVGLS, LVGCS, LVGRS, and LVEF gradually increased, the LVEDV and LVESV gradually decreased. the highest/lowest point was reached at 180 days after PCI treatment. Compared with the control group, the LVGLS, LVGCS, LVGRS, and LVEF at different times were significantly lower than the measure in the control group, while LVEDV and LVESV were significantly higher than the measure in the control group (P<0.05). Conclusions The cardiac left ventricular function of ACS patients was significantly lower than that of normal people. PCI treatment can improve cardiac function, but not to the normal level. Three dimensional speckle tracking technique can be used to evaluate left ventricular function in patients with ACS after PCI.