实时三维超声心动图评价冠心病患者经皮冠状动脉介入治疗前后左心室节段性功能变化

Evaluation of left ventricular segmental function in patients with coronary disease before and after percutaneous coronary intervention by real-time three-dimentional echocardiography

目的运用实时三维超声心动图（RT3DE）的17节段时间-容积曲线及牛眼图评价冠心病患者经皮冠状动脉介入（PCI）手术前后左心室节段性功能变化。方法选取32例经冠状动脉造影证实的冠心病患者，分别于术前、术后1周内行RT3DE检查，获取17节段时间-容积曲线图及牛眼图，应用Qlab软件在机分析，所取参数包括左室收缩运动减低节段数、节段舒张末期容积（rEDV）、节段收缩末容积（rESV）、节段射血分数（rEF）及节段-整体射血分数（rgEF）并进行比较。另选择30例年龄相匹配的健康者作为对照组。结果与对照组比较，PCI术前患者在RT-3DE牛眼图中均显示多处收缩运动减低节段（5．2±1．8），病变节段心功能参数与对照组比较差异有显著统计学意义（P〈0．01）。术后1周内显示病变节段数较术前减少（3．4±1．1），节段心功能参数改善（P〈0．05）。结论RT3DE的牛眼图及17节段时间-容积曲线可定性、定量反映PCI手术前后的左室节段心功能变化，从而为评价冠心病患者的PCI疗效提供了一种新的方法。

Objective To assess left ventricular segmental function in patients with coronary heart disease （CHD） before and after percutaneous coronary intervention（PCI） using volume time curves（VTCs） and Bull＇s Eye images from real-time three-dimentional echocardiography（RT 3DE）. Methods Thirty-two patients with CHD confirmed by coronary angiography were undergone RT 3DE before and 1 week after PCI, respectively. The 17 segmental VTCs and Bull＇s Eye images from RT 3DE were obtained and analyzed by the on line Qlab software. Parameters including the numbers of dyskinetic segments, regional diastolic volume （rEDV）, regional systolic volume（rESV） ,regional ejection fractions（rEF） and the ejection fractions of regional stroke volume to global diastolic volume（rgEF） were compared. Thirty normal subjects were selected as control group. Results Compared with control group,the CHD group before PCI showed more dyskinetic segments（5.2±1.8）,and the parameters of regional heart function reached high significant difference（ P 〈0.01）. By contrast with CHD group before PCI, the numbers of dyskinetic segments reduced and the parameters of regional heart function improved after PCI（ P 〈0.05）. Conclusions Seventeen-segmental volume-time curves（VTCs） and Bull＇s Eye iraages from RT-3DE can assess the effective changes of regional heart function resulted from PCI qualitatively and quantitatively, which providing another useful modality for evaluating the effection of PCI in CHD patients.