应变对心肌梗死患者左心室局域心肌细胞活力和舒张功能的评价

Evaluation of Regional Left Ventricular Cardiocyte Viability and Diastolic Function by Strain Curves in Patients with Myocardial Infarction

目的探讨冠心病患者左心室舒张各期局部心肌应变特点及其评价左心室局域心肌细胞活力和舒张功能的可能性。方法对54例前壁心肌梗死患者(MI组)和78例正常对照者左心室心肌进行组织多普勒成像检查,记录心尖二腔动态图像,应用应变曲线描记技术获取左心室各阶段心肌同步应变曲线,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)局部心肌应变值变化幅度,对两组结果进行对比分析。结果在正常对照组舒张各期,66例(84.62%)的应变值(S)按前壁心尖、心底、中部的顺序,呈负值增大的梯度变化;MI组符合这一规律仅占9例(16.67%)。IR期:正常对照组564节段(90.38%)为向上波段且走行较一致;MI组向上波段有123节段(28.47%),且各节段波走行不一致,两组间的差异有显著性意义(P<0.05)。RF期:正常对照组为快速向上波段(576节段,92.31%);MI组向上波段少(102节段,23.61%),两组间的差异有非常显著性意义(P<0.01)。SF期:正常对照组多为水平波段(537节段,86.1%),MI组在缺血节段多为向上波段(392节段,90.7%),两组间的差异有显著性意义(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应变值异常;应变曲线(SC)能敏感、直观、无创地定量评价局域心肌细胞活力和舒张功能。

Objective To detect the strain features of regional wall abnormalities in patients with coronary artery disease during each diastolic period, and its possibility to evaluate regional left ventricular cardiocyte viability and diastolic function. Methods 54 pa tients with anterior myocardial infarction （MI group） and 78 normal subjects （NOR group） underwent Doppler tissue imaging, which were performed in 2 chamber view by strain curves synchronously. Results In the NOR group, strain value of 66 cases （84.62%） showed an gradually increasing negative value from the apex to base to middle of left ventricle, while in the MI group, there were 9 cases （16.67%） with such a trend. IR phase： in the NOR group, 564 segments （90.38%） were upward wave bands, but in the MI group, there were 123 segments （28.47%） having such waves （P〈0.05）. RF phase： in the NOR group, 576 segments （92.31%） were upward and steep wave bands, but in the MI group, the number of upward waves were obviously less （102 segments, 23.61%） （P〈0.01）. SF period： compared with the NOR group, which was horizontal, the MI group had upward wave bands （ P〈0.05）. Conclusion Regional myocardial ischemia and infarction can cause significant regional diastolic wall abnormalities of strain value in active diastolic phase. Regional diastolic wall motion abnormalities can be evaluated quantitatively and synchronous ly with high sensitivity by strain curve which has the potential value in cardiocyte viability and diastolic function.