实时三维超声心动图评价冠心病患者左前降支冠状动脉PCI术后左心室整体及局部收缩功能与同步性

目的 探讨实时三维超声心动图(RT-3DE)评价冠心病左前降支冠状动脉经皮介入治疗(PCI)后患者左心室整体及局部收缩功能与同步性的应用价值.方法 对30例接受左前降支PCI术的患者分别于术前、术后1周,1、3个月应用RT-3DE进行17节段时间-容积曲线分析,获得左心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及左心室16节段达到最小收缩容积时间差的标准差校正值(Tmsv-16-SD％),即收缩不同步指数(SDI)；同时得到前壁、前间隔及心尖帽共7节段的舒张末期容积(rEDV)、收缩末期容积(rESV)、节段射血分数(rEF)及节段达到最小收缩容积时间的校正值(Tmsv％).结果 术后1个月EDV、ESV、rESV及大部分节段的rEDV低于术前及术后1周(P＜0.05),EF、rEF高于术前及术后1周(P＜0.05),Tmsv-16-SD％及局部节段Tmsv％低于术前(P＜0.05),与术后1周无明显差异(P＞0.05)；术后3个月ESV、Tmsv- 16-SD％及大部分节段的rEDV、rESV、Tmsv％低于术前、术后1周及术后1个月(P＜0.05),EF及大部分节段的rEF高于术前、术后1周及术后1个月(P＜0.05),rEDV低于术前及术后1周,与术后1个月相比较无明显差异(P＞0.0 5).结论 利用RT-3DE能定量评价冠心病患者左前降支PCI术后左心室整体及局部收缩功能与同步性的改善情况.

Real-time three-dimensional echocardiographic evaluation on the whole and regional left ventricular systolic function and synchrony in coronary artery disease patients after PCI of left anterior descending branch

Objective To assess the clinical value of real-time three-dimensional echocardiography (RT-3DE) in evaluating the whole and regional left ventricular systolic function and synchrony in coronary artery disease patients after percutaneous transluminal coronary intervention (PCI) of left anterior descending (LAD). Methods RT-3DE was performed on 30 patients before PCI of LAD and 1 week, 1 and 3 months after PCI. The 17-segmental time-volumetric curves were analyzed, and the global systolic function parameters (EDV, ESV, EF) and synchronic parameters (Tmsv 16-SD%) were obtained. Tmsv 16-SD% was served as the systolic dyssynchrony index (SDI). Regional systolic function parameters (rEDV, rESV, rEF) and synchronic parameters (Tmsv%) were also obtained. Results Compared with before and 1 week after PCI, the global EDV, ESV, rESV and rEDV of most segments decreased 1 month later (P<0.05), while the EF and rEF increased (P<0.05). Tmsv-16-SD% and Tmsv% of some segments decreased compared with those preoperation (P<0.05), while no statistical difference was found with 1 week after PCI (P>0.05). Three months after PCI, the global ESV, Tmsv-16-SD% and rEDV, rESV, Tmsv% of most segments group decreased (P<0.05), while the EF and rEF of most segments increased (P<0.05), the global rEDV decreased compared with preoperation and 1 week after PCI (P<0.05), while no statistical difference was found with 1 month after PCI (P>0.05). Conclusion RT-3DE is a useful method in assessing the whole and regional left ventricular systolic function and synchrony in coronary artery disease patients after PCI of LAD.