经皮冠状动脉介入治疗对冠心病非心肌梗死患者心肌二维应变的影响

Evaluation on the impact of percutaneous coronary intervention in patients with non-infarcted coronary artery disease with two-dimensional strain

目的运用速度向量成像(VVI)技术评价冠心病非心肌梗死患者心肌二维应变以及经皮冠状动脉介入治疗(PCI)的疗效。方法选取经冠脉造影证实并接受PCI手术的非心肌梗死患者20例(PCI组),以及性别、年龄匹配的经冠脉造影除外冠心病的患者20例(对照组)。在术前、出院前及术后3个月接受VVI,测量左心室心肌纵向、径向、圆周方向上的应变及应变率,以及左心室扭转角度,评价病变冠状动脉灌注区内的心肌功能及PCI术后改善情况。结果与对照组对应的血管灌注节段相比,PCI组术前的病变血管灌注节段径向应变、径向收缩期峰值应变率、径向舒张晚期峰值应变率显著降低(均P<0.05);PCI组术前左心室内膜扭转角度较对照组明显下降。PCI组出院前径向应变较PCI组术前出现改善(P<0.01),经向收缩期峰值应变率和舒张晚期峰值应变率在术后3个月得到改善。结论 VVI技术可用于识别灌注异常导致的肉眼无法识别的心肌功能损害;PCI术后早期即可出现径向应变的改善。

Objective To observe the value of two-dimensional strain using velocity vector imaging （VVI） in evaluating the therapeutic effect of percutaneous coronary＇intervention （PCI） in patients with non-infarcted coronary artery disease （CAD）. Methods Twenty non-infarcted CAD patients underwent PCI （PCI group） and 20 age and sex matched subjects （control group） confirmed by coronary angiography （CAG） were enrolled. VVI were acquired before CAG and PCI proce- dures for all subjects, and were repeated in PCI group before discharge and 3 months after PCI. The longitudinal, radial, circumferential regional strain and strain rate, as well as left ventricular torsion were analyzed. The regional myocardial deformation parameters in territory of the stenostic coronary artery in PCI group （ischemic segments） were compared with those of corresponding segments in control group （normal segments）. Post PCI changes of myocardial strain and left ventricular torsion were also followed up to assess the effect of PCI procedure on left ventricular myocardial function. Results Compared to the control group, the radial deformation function of the ischemic segments was damaged, with significantly lower values of radial peak systolic strain rate （SRs） and strain, radial peak late-diastolic strain rate （SRa） in PCI group before operation （all P〈0.05）. Left ventricular torsion obviously decreased in PCI group before operation compared with that in control group, despite ejection fraction. Radial peak systolic strain was improved shortly in group PCI before discharge （P〈0.01）, while radial SRs and SRa were improved in PCI group 3 months after operation. Conclusion VVI can identify the subtle abnormalities of regional and global function secondary to the ischemic, which are ignored by the routine eehocardiography. Radial strain can be improved early after PCI.