RT-3DE技术定量评估急性心肌梗死后血栓抽吸并介入治疗术后左室心功能改变

目的：运用实时三维超声心动图（RT-3DE）检测急性心肌梗死患者（AMI）血栓抽吸并PC1术后及单纯PCI术后左室整体和节段收缩功能的改变.方法：将纳入的55例实施PCI术的AMI患者根据是否于术前采用血栓抽吸分为血栓抽吸＋PCI组和单纯PCI组,运用RT-3DE检查两组患者,比较其术后7天及6月时两组患者整体和节段舒张末期容积（EDV 、rEDV）、整体和节段收缩末期容积（ESV、rESV）、整体和节段射血分数（EF、rEF）.并观察两组患者术后心肌梗死溶栓治疗临床试验（TIMI）3级血流发生率及心电图ST段回落百分比（STR）.结果：血栓抽吸并PCI术组中TIMI 3级、STR≥50％的患者比率较单纯PCI组高（P＜0.05）,血栓抽吸并PCI术组6月时EDV、ESV及rEDV、rESV较单纯PCI组减低,EF、rEF提高（P＜0.05）.另外术后6月时两组患者的△EDV、△EF与术后STR呈正相关.结论：AMI患者血栓抽吸合并PCI术较单纯PCI术更能够提高左室整体及节段心收缩恢复.RT-3DE可准确定量评价AMI患者介入治疗术后左室收缩功能的改变,同时AMI患者中远期△rEDV、△rEF与术后STR可以更好预测介入治疗术后微循环灌注程度及其中远期恢复状况.

RT-3DE in quantitative assessment of left ventricular function after aspiration thrombectomy and percutaneous coronary intervention for patients with acute myocardial infarction

Objective：To investigate the change of global and regional left ventricular systolic function after aspiration thrombectomy in percutaneous coronary intervention （PCI） or single PCI for patients with acute myocardial infarction by realtime three-dimensional echocardiography （RT-3DE）.Methods：Fifty-five subjects with acute myocardial infarction were studied by RT-3DE.And they were divided into two groups with aspiration thrombectomy or without PCI.Then respectively compared the global and regional diastolic volumes （EDV,rEDV）,the global and systolic volumes （ESV,rESV）,the global and ejections fractions（EF,rEF） between the two groups after 1 week and 6 months of PCI,and observed the thrombolysis in myocardial infarction trial（TIMI） and ST segment resolution of electrocardiogram（STR）.Results：Compared with single PCI,TIMI grade 3 and STR≥50％ was better in patients with aspiration thrombectomy.And the EDV,rEDV,ESV,rESV by RT-3DE of patients with single PCI at the six months were larger than that with aspiration thrombectomy in PCI（P＜0.05）,while EF,rEF was lower（P＜0.05）.And the △EDV,△EF of all the patients at the six months had positive correlation with STR.Conclusion：Aspiration thrombectomy in PCI with AMI were more conductive to recover of the left ventricular function by RT-3DE.And △EDV,△EF by RT-3DE and STR can predict clinical prognosis more accurately for AMI with PCI.