脉冲多普勒组织成像评价急性心肌梗死后左室舒缩协调性

Dissynchrony on left ventricular evaluated by pulsed wave Doppler tissue imaging in patients with acute myocardial infarction

目的 定量观察急性心肌梗死患者心脏结构、功能及二尖瓣环不同部位各舒缩参数变化,探讨心肌梗死后左室舒缩协调性的改变。方法 首次心肌梗死患者98例,于心梗后1周行二维超声以及PW DTI检测。测定心脏收缩功能指标EF、收缩速度指标Vs、舒张速度指标Ve, Va、收缩时间指标Q so, Q sp、舒张时间指标Q eo, Q ep;对照组46例行同样检测。结果 急性心肌梗死患者LVDD、LAD即较对照组明显增大(P<0.01),EF明显降低(P<0.01);前壁心梗组二尖瓣内、外、后环Vs及Ve均明显低于对照组(P<0.01),下壁心梗组仅二尖瓣内环、后环Vs明显低于对照组(P<0.01),而内、外及后环Ve均明显低于对照组(分别为P<0.01,P<0.05,P<0.01);前壁、下壁心梗组二尖瓣后环Q so时间与内环、外环有显著差异(分别为P<0.05,P<0.01),而对照组二尖瓣内、外、后环Q so无显著差别。结论 急性心梗后左室结构及室内各瓣环舒缩协调性发生改变,这可能是导致心脏收缩和舒张功能减退的原因之一。

Objective To quantitatively observe the changes of structure, function and movement synchrony parameters of the hear at three points of mitral annular after one week of acute myocardial infarction (AMI) by two-dimensional echocardiography and pulsed wave Doppler tissue imaging (PW-DTI). Methods Ninety-eight AMI patients and 46 matched control subjects were studied. The AMI group was divided into anterior AMI group (anterior group, n=45) and inferior AMI group (inferior group, n=53), and standard echocardiography and PW-DTI were performed. EF was used as systolic function parameter of left ventricular. Vs, Ve, Va were used as systolic, early diastolic, late diastolic velocity parameters of DTI respectively, while Q-so, Q-sp, Q-eo, Q-ep were used as systolic and diastolic time parameters of DTI respectively. Results After one week of AMI onset, LVDD and LAD in AMI group were both larger than those in the control group (P<0.01). EF in AMI group was lower than that in the control group (P<0.01). In anterior AMI group, Vs at three points of mitral annular decreased significantly compared with the control group (P<0.01) and Ve was also lower than that in the the control group (P<0.01). In inferior AMI group, only Vs at inner and posterior annular was lower than that in the control group (P<0.01), but Ve at three points of mitral annular decreased significantly (P<0.01). In the control group, Q-so at three points of mitral annular was not different. In anterior and inferior AMI group, Q-so between inner, lateral and posterior were significantly different (P<0.01). Conclusion After AMI, the changes of dissynchrony of intro-ventricular has taken place. It may be one of the causes of decreased systolic and diastolic function.