QTVI与结合PESP评价左前降支血运重建的疗效及心肌存活性

Assessment of regional wall motion and myocardial Viability with quantitative tissue velocity imaging and postextrasystolic potentiation in patients with revascularization of left anterior descending coronary artery

目的:初步探讨多普勒超声心动图定量组织速度成像(QTVI)及结合期前收缩后强化(PESP),评价左前降支(LAD)冠状动脉血运重建对相关室壁节段运动及心肌存活性的影响。方法:因LAD狭窄接受血运重建术的患者20例,于术前、术后1周测量LAD供血8个心肌节段在窦性心律时和PESP时的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)。并与46例正常人的相应参数相比较。结果:①冠心病组治疗前8个心肌节段中,7个节段的Vs、6个节段的Ve及3个节段的Va低于正常对照组(P<0.05～0.01),术后1周这些节段的3个参数较术前均有不同程度增加,其中4个节段的Vs,2个节段的Ve已恢复到正常水平(P>0.05);②冠心病组20例术前有84个节段Vs异常,术后1周30个节段恢复至正常;③冠心病组治疗前后PESP时各参数均较窦性心律时显著增大(P<0.05～0.01),但术后均无显著变化(P>0.05)。结论:QTVI能用于评价血运重建术疗效;PESP-QTVI评价术后1周心肌的室壁运动变化及心肌存活性的价值似不如QTVI。

Objective：To evaluate the changes of regional wall motion and myocardial Viability with quantitative tissue velocity imaging（QTVI）and postextrasystolic potentiation（PESP）in patients with coronary revascularization（CR）of left anterior descending coronary artery（LAD）.Method：Twenty patients with LAD stenosis （70%-100%）and forty-six normal control subjects were included in this study.QTVI were performed on a day before CR,a week after CR.Peak systolic myocardial velocity（Vs）,peak early diastolic myocardial velocity（Ve） and peak anaphase diastolic myocardial velocity（Va）were measured in the patients with CAD under sinus rhythm and PESP respectively with QTVI,but in normal control subjects only under sinus rhythm.Result：①Before CR, Vs of seven myocardial segments,Ve of 6segments,Va of 3segments were significantly lower than that of normal subjects（P0.05-0.01）.After CR,the above segments showed improvement,among them Vs of 6segments,Ve of 3segments,Va of 1segment was increased significantly（P0.05-0.01）,and Vs of 4segments, Ve of 2segments was already normal.②There were 84abnormal segments in CAD group according to lower limit value of Vs of normal group,30segments resumed to normal leve after significantly larger than those of corresponding segments measured under sinus CR.③Whether CR or not,values of all segments measured by PSPE-QTVI were rhythm（P0.01）.But the values measured under PESP before and after CR was no significantly difference（P0.05）.The change of values measured under PESP after CR was not as markedly as those under sinus rhythm.Conclusion：QTVI is a useful tool for assessment of regional myocardial motion and CR curative effect.Assessment potential of QTVI under PESP appears to be inferior to QTVI under sinus rhytym.