心肌梗死患者左室局域舒张功能的运动幅度成像

Evaluation of Regional Left Ventricular Diastolic Function in Patients with Myocardial Infarction by Distance Imaging

目的探索冠心病患者左心室舒张各期局部心肌运动幅度成像特点及其评价左心室局域舒张功能的可能性。方法对54例前壁心肌梗死病人(M I组)和78例正常对照者(NOR组)左室心肌进行组织多普勒成像检查。记录心尖二腔动态图像,应用运动幅度成像描记技术获取左室各阶段心肌同步幅度曲线,测量等容舒张期(IR)、快速充盈期(RF)、缓慢充盈期(SF)、心房收缩期(AC)局部心肌速度变化幅度,对两组结果进行对比分析。结果在整个舒张期,正常对照组从前壁心尖、中间到心底部,幅度呈正值逐渐减小的梯度变化。M I组梯度变化规律消失,梗死区域幅度为负值。在等容舒张期,正常组为一个较平缓的下降波97.44%(76/78)。M I组则有50%(27/54)为下降波(P<0.05)。在快速充盈期,对照组有97.44%(76/78)为快速下降的波;M I组梗死区域运动幅度为负值(P<0.001)。在缓慢充盈期,正常组多数为靠近基线的水平波;而在M I组,无明显的水平波段(P<0.05)。结论局部心肌缺血梗死导致主动舒张期的局部心肌运动幅度显著异常。运动幅度成像能敏感、直观、无创地定量评价左心室局域舒张功能。

Objective To detect the distance imaging features of regional wall abnormalities in patients with coronary artery disease during each diastolic period, as well as the possibility to evaluate regional left ventricular diastolic function. Methods A total of 54 patients with anterior myocardial infarction （MI group） and 78 normal subjects （NOR group）underwent Doppler tissue imaging, which was performed in 2-chamber view by distance imaging synchronously. Results In NOR group, D value showed a gradually increasing positive value from the apex to middle and to base of left ventricle, while in MI group, such feature disappeared and it was negative in the infarcted area. In isovohimic relaxation period, the palliatively downward wave appeared in 97.44% （76/78） of the subjects in NOR group, and in 50.00% （27/54） of the patients in MI group （ P 〈 0.05 ）. In rapid filling period, both NOR and MI groups showed downward and steep waves, but in MI group, the gradient rule disappeared and D value was negative in the infarcted area （ P 〈 0.001 ）. In slow filling period, compared with NOR group which showed horizontal wave, MI group had no obviously horizontal waves （ P 〈 0.05）. Conclusion Regional myocardial ischemia and infarction can cause significant regional diastolic wall abnormalities of distance in active diastolic phase. Regional diastolic wall motion abnormalities can be evaluated quantitatively and synchronously with high sensitivity by distance imaging which has the potential value in the evaluation of diastolic function.