实时三维超声定量评价急性心肌梗死左室重构及功能

Evaluation of left ventricular remodeling and function by quantitative real-time three-dimensional echocardiography in patients with acute myocardial infarction

目的运用实时三维超声心动图(RT-3DE)定量评价急性心肌梗死(AMI)患者左室重构及功能。方法根据冠脉造影结果将35例AMI患者分为3个亚组:A组(n=9)为左前降支未受累,B组(n=9)为左前降支病变,C组(n=17)为包含左前降支在内的2支以上血管病变;正常对照组29例。分别应用二维超声心动图(2DE)双平面Simpson s法和RT-3DE对左室容积及功能进行分析评价。结果 RT-3DE与Simpson s法在正常对照组中所得结果差异无统计学意义(P>0.05);在AMI组中,Simpson s法的测量值左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)偏低,左室整体射血分数(EF)偏高(P<0.05)。RT-3DE与Simpson s法的测量结果A组与B组间比较差异无统计学意义(P>0.05),而C组经Simpson s法测量的LVEDV、LVESV明显偏低,EF明显偏高(P<0.01)。AMI各组间RT-3DE测量值比较结果显示,C组的LVEDV、LVESV明显高于A、B组,EF明显低于A、B组(P<0.01)。结论 RT-3DE能够无创、简便、较准确地定量评价AMI患者左室重构和心功能改变,对于包含左前降支的多支冠脉病变及程度较重的患者具有一定的临床意义。

Objective To investigate the application of quantitive real-time three-dimensional echocardiography(RT-3DE) in evaluation of left ventricular remodeling and function in patients with acute myocardial infarction(AMI). MethodsThirty-five patients with AMI(AMI group) were divided into 3 subgroups according to the results of coronary angiography.In subgroup A(n=9),left anterior descending artery was not involved;in subgroup B(n=9),only left anterior descending artery was involved;and in subgroup C(n=17),left anterior descending artery was involved in multi-vessel disease.Besides,29 healthy subjects were served as normal controls.Left ventricular volume and left ventricular function were measured by two-dimensional echocardiography(2DE) biplane Simpson's method and RT-3DE. Results There was no significant difference between the findings of RT-3DE and those of Simpson's methods in normal control group(P>0.05).In AMI group,LVEDV and LVESV measured by Simpson's method were lower than those measured by RT-3DE,while EF measured by Simpson's method was higher than that measured by RT-3DE(P<0.05).There was no significant difference between the findings of RT-3DE and those of Simpson's methods in subgroup A and subgroup B(P>0.05).In subgroup C,LVEDV and LVESV measured by Simpson's method were lower than those measured by RT-3DE,while EF measured by Simpson's method was higher than that measured by RT-3DE(P<0.01).LVEDV and LVESV in subgroup C were significantly higher than those in subgroup A and subgroup B measured by RT-3DE,while EF in subgroup C was significantly lower than that in subgroup A and subgroup B measured by RT-3DE(P<0.01). Conclusion RT-3DE allows non-invasive,accurate and quantitative evaluation of left ventricular remodeling and function in patients with AMI,and it is of clinical significance for those with severe and extensive coronary artery disease,such as multi-vessel coronary disease with left anterior descending artery involved.