摘要
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.
出处
《中国医学影像技术》
CSCD
北大核心
2014年第9期1358-1362,共5页
Chinese Journal of Medical Imaging Technology
基金
首都卫生发展科研专项基金(2011-5004-01)