自动功能成像评估急性心肌梗死患者左心室功能及梗死范围

目的 应用二维斑点追踪自动功能成像(AFI)技术评价急性心肌梗死(AMI)患者的左心室功能，及其与AMI常规心肌标志物肌钙蛋白T(cTnT)以及心电图ST段抬高的相关性，探讨AFI的临床应用价值。方法 获取46例首发AMI患者（心肌梗死组）和30例年龄性别相关受检者（对照组）的二维超声图像，同时记录12导联心电图和AMI患者入院24 h的cTnT值，应用AFI技术实时获取左室收缩峰值纵向应变(LPSS)及其牛眼图。结果 与对照组相比，心肌梗死组的左室射血分数(LVEF)、LPSS明显减低(P ＜0.001)，ST段明显抬高(P＜0.001)；整体LPSS与梗死节段LPSS均与LVEF呈负相关，整体LPSS与LVEF的相关性较高（r=-0.660）；整体LPSS与梗死节段LPSS均与cTnT呈正相关(P＜0.001)，LVEF与cTnT呈负相关(P=0.002)，梗死节段LPSS与cTnT的相关性较高(r=0.598)；整体LPSS与梗死节段LPSS均与ST段抬高呈正相关(P＜0.05)。结论整体LPSS能准确评价AMI患者的左室收缩功能，梗死节段LPSS能准确评价AMI患者的梗死受累范围和程度。AFI作为简易快捷的程序性诊断工具可为临床评价AMI提供有价值的信息。

Assessment of left ventricular function and infarct size of acute myocardial infarction by automated function imaging

Objective To assess the left ventricular function of patients with acute myocardial infarction (AMI) and its correlation with cardiac troponin T (cTnT) and specific manifestation of electrocardiogram (ECG) by automated function imaging (AFI) of two-dimensional speckle tracking imaging.Methods Forty-six AMI patients who had AMI for the first time and had been treated by primary percutaneous coronary intervention and 30 healthy controls who were age and sex-related to infarct group were involved.The values of cTnT within 24 hours after admission of AMI patients were recorded and the values of ST segment elevation were measured accurately.All the subjects were analyzed for longitudinal peak systolic strain (LPSS) values and the bull' s eyes by AFI.Results Compared to control group, left ventricular ejection fraction (LVEF), global and infarcted LPSS of infarct group were significantly different and the values of ST elevation of infarct group were higher than those of control group.Both global,infarcted segmental LPSS were significant closely correlated to LVEF and cTnT,respectively (P＜0.001,all).Both global, infarcted segmental LPSS were correlated to ST elevation (P ＜0.05,all).Global LPSS had the closest correlation with LVEF (r = -0.565, P＜0.001) and so did infarcted LPSS with cTnT (r = 0.432, P ＜0.01).Conclusions As a procedural simple and rapid diagnostic tool,AFI provides reliable and useful information of the assessment of AMI.Both global and infarcted segmental LPSS have well described left ventricular function of AMI patients.Compared to LVEF, LPSS was more closely correlated to cTnT and ST segment elevation, which meant that LPSS was more sensitive and more closely related to real infarct size and actual involved range of AMI.