探讨组织多普勒超声评价介入术后冠心病患者左心室重构的意义

Assessment of left ventricular remodeling by Doppler tissue imaging in patients with coronary heart disease after percutaneous coronary intervention

目的:分析多普勒超声技术作为评价经皮冠状动脉介入术对冠心病患者左心室重构影响的临床价值,探讨二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度的比值与左心室质量指数的相关性。方法:52例冠心病患者分为行经皮冠状动脉介入术组33例(A组)和未行经皮冠状动脉介入术组19例(B组),A组于经皮冠状动脉介入术前5d及术后5d、3个月、6个月随访,B组于冠状动脉造影术后2d及术后6个月随访;均行常规超声检查,观察经皮冠状动脉介入术后左心室重构的变化情况。测定二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度的比值。进行二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度的比值与左心室质量指数的相关性研究。结果:二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度的比值与左心室质量指数存在相关性(P<0.05)。6个月后B组左室射血分数、左心室质量指数明显增高(P<0.01)。左心室收缩末期容积指数、左心室舒张末期容积指数较术前增高(P<0.05)。结论:二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度的比值可能有助于评价冠心病经皮冠状动脉介入术后左心室重构情况。超声技术可作为评价冠心病患者经皮冠状动脉介入术后左心室重构的便捷方法。

Objective To study the clinical value of Doppler tissue imaging to left ventricular remodeling in the patients with coronary heart disease after percutaneous coronary intervention, and to evaluate the corerelation of E/Ea with left ventricular mass index. Methods Fifty-two patients with coronary heart disease were divided into two groups, group A（n=33） and group B（n=19）. Group A received percutaneous coronary intervention and group B received normal drug management. Group A was performed examination with PW-DTI and conventional echocardiography before intervention and the 5th day, the 3rd month and 6th month after intervention, and group B received the examinations before and 6th month after angiography. Left ventricular end-diastolic volume and left ventricular end- systolic volume were measured with the standard 2-D echocardiography. The early diastolic velocity of mitral annulus and the early diastolic mitral blood velocity were measured with Doppler tissue imaging. Results There was a correlation between E/Ea and left ventricular mass index（P%0.05）. The left ventricular end systolic volume index and left ventricular end-diastolic volume index in group B were significantly elevated in the 6th month after angiography（P〈0.01, P〈20.05）. Conclusion E/ Ea has a clinic value to evaluating the left ventricular remodeling of coronary heart disease patients. Doppler tissue imaging is a useful and optional tool to evaluate the effect of percutaneous coronary intervention on patients with coronary heart disease.