定量组织速度成像技术对AMI患者PCI术前、后左室舒张功能的评价

Evaluation of the Changes of Left Ventricular Diastolic Function in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention Therapy by Quantitative Tissue Velocity Imaging

目的应用超声心动图定量组织速度成像(QTVI)技术评价急性心肌梗死(AM I)患者行皮冠状动脉介入(PC I)术前、后的左室舒张功能。方法 30例首次确诊为AM I患者,行PC I术前及术后1个月和3个月行常规超声心动图检查及QTVI测定二尖瓣环运动速度频谱,并分析左室舒张功能评价资料。结果 30例AM I患者术后1、3个月分别与术前比较,左室舒张早期最大血流速度(E)及其与左室舒张晚期最大血流速度(A)比值E/A、二尖瓣环平均舒张早期运动速度(Eam)及其与舒张晚期运动速度(Aam)比值Eam/Aam增高,心率(HR)、E/Eam显著减低(均为P<0.01);术后3个月与术后1个月比较,E、Eam、E/A、Eam/Aam增高(P<0.05或P<0.01),E/Eam减低(P<0.01),HR未见明显变化(P>0.05)。本组AM I患者舒张功能异常以充盈迟缓型为主,少数为假性正常型,未见限制型。等容舒张时间在舒张功能充盈迟缓时延长,假性正常化时缩短至正常范围(P<0.01)。年龄、HR都是舒张功能的影响因素(P<0.05或P<0.01)。结论年轻AM I患者的舒张功能在PC I术后显著提高,QTVI所测E/Ea可反映左室舒张功能异常,Ea、Ea/Aa E/A联合及IRT可更准确地反映左室舒张功能异常程度,估测AM I后左室心肌缺血受损程度。

Objective To evaluate the changes of left ventricular diastolic function in patients with acute myocardial infarction （AMI） before and after emergency PCI by quantitative tissue velocity imaging （QTVI） of Echocardiography. Methods 30 cases of first diagnosed with AMI during hospitalization underwent PCI were followed-up both before underwent emergency PCI and after the first, the third month, by both two-dimensional echocardiography and QTVI. The changes of left ventricular diastolic function were evaluated. Results AMI after PCI 1,3 month compared with preoperative ,the peak velocity at early diastole （E） and with peak velocity at late diastole（A） ratio -E/A mitral annulus mean velocities during early diastole （Eam）, and with atrial contraction（Aam） ratio- Eam/Aam significantly increased and E/Earn, heart rate （HR） significantly decreased （ P 〈 0.01 ） ; after PCI 3 months compared with 1 months, E, Eam, E/A, Eam/Aam significantly increased （ P 〈 0.01 or P 〈 0.05 ）, and E/Eam significantly reduced （ P 〈 0.01 ） ; heart rate （HR） has no significant change （ P 〉 0.05 ）. This AMI group diastolic disfunction showed mainly fulls slowly and minority showed pseudo normal. Isovolumic relaxation time prolonged when Ventricular diastolic disfunction was light, it shortened to the normal range when Ventricular diastolic function was pseudo-normalization. The age, HR were the influencing factors on diastolicfunction （P 〈 0.05 or P 〈 0.01 ）. Conclusion E/Ea can evaluate left ventricular diastolic dysfunction. E/Ea, Ea / Aa, E/A and joint IRT can accurately evaluate left ventricular diastolic function in patients with AMI after emergency PCI.