背向散射积分评价冠心病介入治疗术后心肌灌注恢复特性

Recovery characteristics of myocardial perfusion by integrated backscatter after interventional treatment of coronary artery stenosis

目的 应用背向散射积分(IBS)技术定量评价 PTCA支架植入术后心肌灌注的恢复特性。方法 选择 40 例PTCA支架植入术的患者,其中心肌缺血组和心肌梗死组各 20 例。用 IBS技术,于手术前、术后 3 天、1 个月和 3 个月测量支架植入血管所对应的供血心肌节段 IBS和 IBS的变化幅度(CVIB),测量左室射血分数(EF)、左室短轴缩短率(FS)、二尖瓣血流E/A值和左室等容舒张时间(IVRT)。结果 心肌缺血组和心肌梗死组心肌 IBS降低和CVIB升高分别出现在术后3天和1月。梗死组心肌EF值与FS值术后3次随访均较术前增加;缺血组心肌收缩功能的改善出现在术后3个月。缺血组和梗死组术后E/A增加,IVRT减小分别出现在术后3个月和 1 个月。缺血组和梗死组左室 EF分别与心肌的CVIB呈正相关(r值分别为0.546和0.537),与校正 IBS呈负相关(r值分别为-0.561 和-0.556)。结论 IBS技术可定量评价PTCA支架植入术后心肌的血供恢复和功能变化,心肌缺血和心肌梗死术后心肌灌注的改善各具特征。

Objective To quantitatively evaluate the characteristics of myocardial perfusion after percutaneous transluminal coronary angioplasty (PTCA) and stenting using the integrated backscatter (IBS). Methods According to electrocardiogram and angiography, forty patients who underwent PTCA with stent implantation were divided into two groups: myocardial ischemia group ( n =20) and myocardial infarction group ( n =20). The myocardial IBS and the cyclic variation of integrated backscatter (CVIB) of the corresponding segments of stent positioned vessel, left ventricular ejection fraction (EF), fraction shortening (FS), transmitral E/A value and left ventricular isovolumetric relaxation time (IVRT) were respectively measured pre-PTCA, post-PTCA 3 days, 1 month and 3 months. Results Compared with pre-PTCA, CVIB increased and IBS decreased respectively in myocardial ischemia group 3 days and myocardial infarction group 1 month. Systolic and diastolic function were improved respectively in myocardial ischemia group 3 moths, and myocardial infarction group 3 days, 1 month after PTCA stenting. There were positive and negative correlation between CVIB, IBS and EF respectively. Conclusion IBS can be used to quantitatively evaluate myocardial perfusion and left ventricular function. The improvement of myocardial perfusion has its own characteristics in myocardial infarction and ischemia after PTCA stenting.