实时三维超声心动图评价冠心病患者经皮冠状动脉介入术后左心室功能及收缩同步性

Real-time three-dimensional echocardiography evaluation of the left ventricular function and systolic synchrony in patients with coronary heart disease after PCI

目的探讨实时三维超声心动图(RT-3DE)评价经皮冠状动脉介入术(PCI)后患者左心室功能和心肌收缩同步性的价值。方法将研究对象分为两组,PCI组为30例经冠状动脉造影(CAG)证实左前降支狭窄患者,对照组20例为CAG检查证实冠状动脉狭窄<30%患者,对所有患者术前3天及PCI组患者术后3天、术后3个月进行RT-3DE检查,获得左心室17节段时间-容积曲线及时间位移牛眼图和相应参数,心功能参数包括左心室舒张末期容积(EDV)、左心室射血分数(EF),左心室前壁及前室间隔基底段、中间段、心尖段的平均舒张末期容积(rEDV')、平均射血分数(rEF'),峰值充盈率(PFR);同步性参数包括左心室16节段达到最小容积时间的最大差值、标准差及其校正值(Tmsv16dif、Tmsv16sd、Tmsv16dif%、Tmsv16sd%),左心室17节段最大位移(Emax)、最小位移(Emin)、平均位移(Ea)、位移标准差(Esd)及节段位移离散度(Esd/Ea),不同步节段数(DS)、缺血或梗死节段数(IIS)。对以上参数进行统计学分析。结果术前PCI组EDV、rEDV'、Tmsv-16dif、Tmsv-16sd、Tmsv-16dif%、Tmsv-16sd%、Emax、Esd、Esd/Ea、DS、IIS均大于对照组(t=2.24~3.19,P均<0.05),EF、rEF'、PFR、Ea、Emin均小于对照组(t=-3.07^-2.12,P均<0.05)。PCI组术前3天与术后3天各参数比较差异无统计学意义(P均>0.05);术后3个月与术前3天比较,EDV、rEDV'、Tmsv-16dif、Tmsv-16sd、Tmsv-16dif%、Tmsv-16sd%、Emax、Esd、Esd/Ea、DS、IIS减小;EF、rEF'、PFR、Emin、Ea增大(F=3.79~17.28,P均<0.05)。PCI组患者术前3天、术后3个月的rEF'与EF、Esd/Ea与Tmsv-16sd%呈正相关(r=0.793、0.478,P均<0.01),Esd/Ea与EF、PFR与IIS呈负相关(r=-0.454、-0.739,P<0.01)。结论 RT-3DE可定量测量PCI术后患者的心功能及同步性参数,进而评价缺血心肌的恢复情况,为PCI术后疗效的评估提供一种新的无创性方法。

Objective To assess the left ventricular function and synchrony in patients with coronary heart disease after PCI by real-time three-dimensional echocardiography （RT-3DE）. Methods All subjects were divided into two groups： PCI group consisted of 30 patients with left anteriar descending stenosis according to angiocardiography, control group consisted of 20 patients with coronary atery stenosis 〈30%. All subjects were examined with RT-3DE. The 17-segmental time-volume curve and the illustration of the bull＇s eye were analyzed, the global and regional function parameters including end diastolic volume （EDV）, ejection fraction （EF）, regional end diastolic volume; （rEDV＇）, regional ejection fraction＂ （rEF＇）, peak filing rate （PFR）, and synchronic parameters including minimum of time difference in maximum, standard deviation and correction （Tmsvl6dif, Tmsvl6sd, Tmsvl6dif%, Tmsvl6sd%）, E Emln, Ea, Esd, Esd/Ea, dyssynchrony segments （DS）, ischemic or infarction segments （IIS） were obtained. The statistical analysis was performed. Results Before PCI, EDV, rEDV＇, Tmsv-16dif, Tmsv-16sd, Tmsv-16dif%, Tmsv-16sd%, E Esd, Esd/Ea, DS, IIS of PCI group were larger than those of control group （t=2. 24--3.19, all P〈0.05）, EF, rEF＇, PFR, Ea, Emin were lower than those of control group （t= --3.07----2.12, all P〈0.05）. In PCI group, all parameters showed no significant changes by comparison with the cardiac conditions 3 days after PCI and 3 days before PCI （all P〈0. 05）. EDV, rEDV, Tmsv-16dif, Tmsv- 16sd, Tmsv-16dif%, Tmsv-16sd%, E Esd, Esd/Ea, IIS, DS of three months after PCI were significantly lower than those of before PCI, but EF, rEF＇, PFR, Emin, Ea were larger than those before PCI （F= 3. 79--17. 28 , all P〈0.05）. In PCI group, before and after PCI, the rEF＂ and EF, Tmsv-16sd% and Esd/Ea had positive correlations （r= 0. 793, 0. 478, P〈0.01）, Esd/Ea and EF （r= --0. 454, P〈0.01）, PFR and IIS （r= --0. 739, P〈0.01） had negtive correlations （r= --0. 454, --0. 739, P〈0.01）. Conclusion RT-3DE can quantitatively assess left ventricular function and synchrony in patients with CHD, which can be applied as a noninvasive method for evaluating the effect of PCI.