实时心肌超声造影结合二维应变评价经皮冠状动脉重建术后心肌灌注与收缩功能改变

目的 应用实时心肌超声造影(RT-MCE)结合二维应变(2DS)、左心室射血分数(LVEF)评价急性心肌梗死经皮冠状动脉介入术(PCI)后心肌灌注情况与收缩功能的变化.方法对45例急性心肌梗死患者PCI术后1周内行RT-MCE,按照目测定性和半定量法将所有患者分成再灌注良好组、无灌注组和再灌注减弱组,采用Qlab软件计算出各组心肌的充盈速度和心肌的血容量.3组术后3个月复查常规超声心动图测量LVEF及应用2DS软件测量各个节段的收缩期纵向峰值应变(SRs),并将3组LVEF和SRs进行比较.结果 心肌再灌注良好组术后3个月LVEF为(0.60±0.06)%,较术后1周LVEF(0.54±0.05)%增大,差异有统计学意义( t=3.402,P＜0.01).术后3个月时,心肌灌注良好组LVEF、左心室心肌SRs分别为(0.60±0.06)%、(-0.96±0.35)s-1,无灌注组分别为(0.41±0.08)%、(-0.43±0.14)s-1,两组比较差异有统计学意义(t= 2.819、3.214,P均＜0.01);心肌灌注减弱组LVEF、左心室心肌SRs分别为(0.53±0.05 )%、(-0.59±0.31)s-1,与无灌注组比较差异有统计学意义(t= 2.209、2.418,P＜0.05).结论 PCI术后心肌灌注改善与否可以反映心肌功能恢复的趋势,而2DS可较好地定量评价局部心肌收缩功能.

Assessment of myocardial perfusion and systolic function in patients with coronary artery disease after percutaneous coronary intervention by real-time myocardial contrast echocardiography and two-dimensional strain echocardiography

Objective To assess the changes of myocardial perfusion and systolic function in patients with acute myocardial infarction after revascularization by real-time intravenous myocardial contrast echocardiography(RT-MCE) combined with 2D-Strain(2DS).Methods Forty-five patients were examined by RT-MCE within one week after percutaneous coronary intervention(PCI).These patients were divided into groups according to qualitation and demi-quantitation method.The myocardial filling speed and blood volume were calculated by Qlab software.Three months later,the echocardiography was rechecked again to measure the left ventricular ejection fraction(LVEF)and 2DS was used to measure the SRs of every segment of left ventricle.Results Three months after PCI,LVEF[(0.60±0.06)% vs(0.54±0.05)%,t=3.402,P<0.01]increased in the group with better myocardial perfusion compared to one week after PCI.The level of LVEF[(0.53±0.05)% vs(0.41±0.08)%,t= 2.209,P<0.01]and SRs[(-0.59±0.31)s-1 vs(-0.43±0.14)s-1,t=2.418,P<0.01]were both higher in the group with decreased perfusion than those in the group with no perfusion.Also,the level of LVEF[(0.60±0.06) % vs(0.41±0.08)%]and SRs[(-0.96±0.35)s-1vs(-0.43±0.14) s-1] in the group with better perfusion were much higher than those in the group with no perfusion,There were significant differences between the two groups(t=2.819,3.214,all P<0.05).Conclusion The improvement in the myocardial perfusion after PCI could reflect the tendency of myocardial function recovery,and 2DS could be used to quantitate the regional systolic function.