组织多普勒显像评价心肌梗死患者自体骨髓干细胞移植后左室功能

Assessment of Left Ventricular Function by Tissue Doppler Imaging in Patients after Autologous Bone Marrow Stem Cells Transplantation

目的:运用组织多普勒新技术评价非急性前壁心肌梗死患者自体骨髓干细胞移植后的左室节段功能。方法:入选4 例非急性前壁心肌梗死患者,经冠状动脉造影证实无明显的(>30%)冠脉再狭窄,未行PTCA或支架植入术而单纯经冠脉移植骨髓单个核细胞,同时给予标准药物治疗,随访移植前和移植后3个月的超声心动图。运用组织多普勒显像测量左室长轴16个节段的速度、位移、应变力/率。在常规二维超声下测量左室射血分数,并评价室壁运动积分指数。结果:移植3 个月后, 患者左室前壁与下壁、前间隔与后壁之间收缩期峰值速度差值明显减小(P<0.05);左室收缩后收缩节段数降低14.06%(P>0.05);梗死节段收缩期纵向位移明显增大(P<0.05);梗死节段收缩期、舒张早、晚期应变力/率与正常节段比较无明显差异(P>0.05),以中间段和心尖段改善更显著(P< 0.05);左室射血分数(LVEF)明显升高[(44.25±6.29)% 对(53.5±6.45)%, P<0.05],室壁运动积分指数呈下降趋势(1.64±0.14 对1.41±0.48,P>0.05)。结论:(1)非急性心肌梗死患者经冠脉移植自体骨髓干细胞3个月后,梗死心肌节段收缩与舒张功能均提高,以心尖段和中间段改善更显著。(2)组织速度、位移、应变力/率显像在检测局部心肌功能方面较传统心超更敏感。

Objective: Using tissue doppler imaging (TDI) to evaluate the left ventricular (LV) segmental function in patients with old myocardial infarction after autologous mononuclear bone marrow stem cells (BMCs) transplantation. Methods: 4 patients with old myocardial infarction were selected for pure transplantation of BMCs plus standard drug therapy, all proven by angiography with no severe coronary occlusion (>30%). TDI were performed before and 3 months after transplantation. Tissue velocity, displacement, strain and strain rate on 16 segments of the LV wall were measured by TDI. LV ejection fraction (LVEF) and wall motion score index (WSMI) were assessed using 2-D echocardiography. Results: Three months later, difference of peak systolic velocity(Sm-d) between infarcted and normal region decreased significantly (P< 0.05),number of post-systolic shortening segments decreased by 14.06%(P> 0.05); Displacement,systolic strain and strain rate, early and late diastolic strain rate of the infracted areas mounted evidently (P< 0.05), especially in the middle and apical LV segments(P< 0.05). LVEF significantly increased [(44.25±6.29)% vs (53.5±6.45)%,P< 0.05],and WMSI decreased (1.64±0.14 vs 1.41±0.48,P> 0.05). Conclusion:(1)Selective intracoronary transplatation of BMCs in patients with old myocardial infarction can improve their systolic and diastolic function, especially in middle and apical segments. (2)TDI can assess the LV segmental function more sensitively than traditional echocardiography.