二维斑点追踪技术评价心肌梗死患者冠脉内支架术后左室收缩同步性变化

Application of Speckle Tracking Imaging in the Evaluation of Left Ventricular Systolic Synchrony in Patients with Myocardial Infarction after Percutaneous Coronary Intervention

目的探讨斑点追踪成像技术(speckle tracking imaging,STI)评价心肌梗死患者冠脉内支架1置入术(percutaneous coronary intervention,PCI)前后左室收缩同步性的应用价值.方法病例组选取30例心肌梗死拟行冠脉内支架置入术的患者,正常对照组选取35例,对正常对照组及接受PCI治疗的患者在术前、术后1周、1个月、3个月、6个月时进行常规超声心动图检查和斑点追踪成像技术分析,测量左室舒张末期内径(LVDd)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV),以及左室各个心肌节段在纵向、径向、圆周方向三方面达到峰值应变所需要的时间(TPSLS、TPSRS、TPSCS),并计算纵向应变、径向应变、环向应变达峰时间标准差(Tssl-SD、Tssr-SD、Tssc-SD),比较分析各参数在PCI手术前后的变化差异,结合分析左室收缩同步性的改变.结果与正常对照组比较,病例组PCI治疗前左室LVDd、LVESV、LVEDV较对照组扩大,LVEF比对照组降低,差异均有统计学意义(P<0.05);与PCI治疗前比较,PCI术后1周、1个月LVDd、LVESV、LVEDV及LVEF都没有明显改变,差异无统计学意义(P>0.05);PCI治疗后3个月、6个月时LVDd、LVESV、LVEDV比PCI治疗前及PCI治疗后1周、1个月都有一定的缩小,LVEF增高,差异均有统计学意义(P<0.05).与正常组比较病例组术前Tssl-SD、Tssr-SD、Tssc-SD均增大,差异有统计学意义(P<0.05);术后1周、术后第1个月与术前比较Tssl-SD、Tssr-SD、Tssc-SD变化不明显,差异无统计学意义(P>0.05),术后3个月、术后6个月Tssl-SD、Tssr-SD、Tssc-SD与术前及术后1月比较有不同程度的降低,差异有统计学意义(P<0.05).结论心肌梗死导致左室收缩同步性下降,冠状动脉支架术后左室收缩同步性逐步恢复,斑点追逐成像能够定量评价PCI术后左室收缩同步性的改变.

Objective To investigate the application value of speckle tracking imaging（STI） in evaluation of left ventricular systolic synchrony in acute myocardial infarction patients before and after percutaneous coronary intervention（PCI）. Methods 30 patients with myocardial infarction were selected as PCI group,35 healthy people were selected as normal control group.Patients in the normal control group and PCI group received echocardiography and speckle tracking imaging. Before PCI and one week,one month,three months,six months after PCI,we measured Left ventricular diastolic dimention,Left ventricular end-diastolic volume,Left ventricular end-systolic volume,and the time to peak systolic longitudinal strain（TPSLS）,the time to peak systolic radial strain（TPSRS）,the time to peak systolic circle strain（TPSCS）. We also calculated the standard deviation of timeto peak systolic longitudinal strain（Tssl-SD）, the standard deviation of time to peak systolic radial strain（Tssr-SD）,the standard deviation of time to peak systolic circle strain（Tssc-SD）.The difference in these indexes between before and after PCI was analyzed and the change in the left ventricular systolic synchrony was also anlyzed.Results Compared with the control group, LVDd, LVESV and LVEDV were significantly increased and LVEF was significantly decreased in PCI group before and after PCI（P 〈0.05）. Compared with before PCI in PCI group, LVDd, LVESV, LVEDV and LVEF were not significantly different one week and one month after PCI（P〉0.05）. Compared with one week and one month after PCI, LVDd, LVESV, LVEDV were significantly decreased and LVEF were significantly increased three months and six months after PCI（P〈0.05）. Compared with the control group,Tssl-SD,Tssr-SD and Tssc-SD were significantly increased in PCI group before PCI（P〈0.05）. Compared with before PCI in PCI group,Tssl-SD,Tssr-SD,Tssc-SD were not significantly different after one week,one month after PCI（P〉0.05）,and were significantly improved after three months and six months after PCI（P〈0.05）. Conclusions The left ventricular systolic synchrony in patients with myocardial infarction is significantly impaired, and can be recovered gradually after PCI. STI technology could quantitatively evaluate left ventricular systolic synchrony before and after PCI.