实时三维超声心动图结合组织多普勒对急性心肌梗死后右室功能的评估价值

Evaluated value of right ventricular function on patients with acute myocardial infarction by RT-3DE and tissue Doppler imaging

目的探讨实时三维超声心动图及组织多普勒成像技术结合Tei指数对急性心肌梗死PCI术后患者右心室整体功能的评估价值。方法正常对照组40例(Ⅰ组),急性前壁心肌梗死患者40例(Ⅱ组),急性下壁非合并右室心肌梗死患者32例(Ⅲ组),急性下壁合并右室心肌梗死患者14例(Ⅳ组)。在标准心尖四腔心观二维图像指引下,采用TDI的频谱多普勒技术记录三尖瓣环与右室游离壁及中心纤维支架结合处,以及右室游离壁的基底段、中间段及心尖段的运动速度曲线,测量各期最大运动速度,计算Tei指数。应用实时三维超声心动图测量各组右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室射血分数(RVEF)。对结果进行统计学分析。结果与Ⅰ组相比,Ⅱ组在三尖瓣环右室游离壁处收缩期峰值运动速度降低(P<0.05)、Tei指数显著升高(P<0.01),右室游离壁心尖段的舒张早期峰值运动速度及收缩期峰值运动速度降低(P<0.05);与Ⅰ组相比,Ⅱ组、Ⅲ组、Ⅳ组在三尖瓣环中心纤维支架处的收缩期峰值运动速度、心房收缩期峰值运动速度降低(P<0.05),Ⅱ组、Ⅲ组的舒张早期峰值运动速度也显著降低(P<0.01),Ⅱ组在此处的Tei指数也明显升高(P<0.01);与Ⅰ组相比,Ⅲ组、Ⅳ组患者的RVEDV、RVESV明显增大(P<0.05),以Ⅳ组为著(P<0.01);Ⅳ组的RVEF明显减小(P<0.01)。结论实时三维超声心动图能反映急性心肌梗死导致的右室收缩功能减低,其与组织多普勒技术结合测量有利于全面评价心肌梗死后右室整体功能。

Objective To evaluate the right ventricular （RV） function of acute myocardial infarction （AMI） after primary percutaneous coronary intervention （PCI） with Real-time three-dimensional echocardiography （RT-3DE） and tissue Doppler imaging and Tei index. Methods Forty patients with a first acute anterior MI （groupⅡ） and thirty-two patients with a first a-cute inferior MI （without right ventricular MI, groupⅢ） and fourteen patients with a first acute inferior MI with right ventricular MI （groupⅣ） were prospectively compared with forty age-matched healthy individuals （groupⅠ）. From the echocardiographic apical 4-chamber views, peak systolic velocities （Sm） and peak early diastolic velocity （Em） and late diastolic velocities （Am） of the tricuspid annulus were recorded at the RV free wall and septal by tissue Doppler imaging ,as well as basal segment and middle segment and apical segment of the RV free wall. The Tei index by TDI were calculated respectively at the same site. Right ventricular end-diastolic volume （RVEDV）,right ventricular end-systolic volume （RVESV） and right ventricular ejection fraction （RVEF） were measured by using RT-3DE. Results Compared with groupⅠ, Sm of the tricuspid annulus at the RV free wall reduced（P〈0.05） and Tei index increased（P〈0.01）, the Em and Sm of the apical segments of the RV free wall reduced （P〈0.05） in groupⅡ;compared with groupⅠ, the Sm and Am of the tricuspid annulus at the septal reduced （P〈0.05） in groupⅡand groupⅢ and group Ⅳ, the Em reduced （P〈0.01） in groupⅡand groupⅢ, Tei index increased （P〈0.01） in groupⅡ;Compared with groupⅠ, RVEDV and RVESV increased （P〈0.05） in groupⅢ and groupⅣ,and RVEF reduced （P〈0.01） in groupⅣ. Conclusion RT-3DE combined with tissue Doppler imaging can show the impaired RV function in association with the acute MI,it may be used to assess RV function.