二维斑点追踪技术评价急性心肌梗死患者经皮冠状动脉介入治疗后冠状动脉侧支循环对左心室功能的影响

Two-dimensional speckle tracking echocardiographic evaluation of effect of coronary artery collateral circulation on left ventricular function in patients with acute myocardial infarction after percutaneous coronary intervention

目的采用二维斑点追踪成像(STE)技术评价急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉侧支循环(CCC)对左心室功能的影响。方法选择接受急诊PCI的AMI患者51例,根据冠状动脉造影结果将患者分为有侧支循环组(CCC组)和无侧支循环组(N-CCC组)。再根据冠状动脉闭塞情况及室壁运动评分将患者左心室18节段心肌分为正常心肌组、缺血心肌组和梗死心肌组。患者分别在PCI术后72h及1个月接受超声检查,检测并比较左心室心肌整体收缩、舒张功能及心肌纵向应变(LS)和应变率(LSR)。结果与术后72h比较,1个月时CCC组和N-CCC组缺血及梗死心肌的LS均增大(P<0.01)。术后72h,CCC组缺血心肌LSR-s大于N-CCC组(P<0.05)。术后1个月,CCC组缺血及梗死心肌LS均大于N-CCC组(P<0.05),且恶性心律失常发生率低于N-CCC组(P<0.05)。结论 CCC可显著改善AMI患者PCI术后72h缺血心肌和术后1个月缺血、梗死心肌的收缩功能及左心室整体舒张功能。

Objective To evaluate the effect of coronary artery collateral circulation（CCC）on left ventricular function in patients with acute myocardial infarction（AMI）after percutaneous coronary intervention（PCI）with two-dimensional speckle tracking echocardiography（STE）.Methods Totally 51 AMI patients were performed PCI,who were divided into CCC group and N-CCC group based on the coronary angiography.According to the results of coronary artery occlusion and the wall motion score,the 18 segments myocardium of left ventricle were divided into 3subgroups：Normal myocardium,ischemic myocardium and infracted myocardium.Echocardiography was performed in 72 hand 1month after PCI.The longitudinal strain（LS）and strain rate（LSR）were measured to assess the LV global systolic and diastolic functions.Results LS in ischemic and infracted myocardium of all the patients 1month after PCI increased compared with that in 72h（P〈0.01）.LSR-s of ischemic myocardium in CCC group was higher than that in N-CCC group 72 hafter PCI（P〈0.05）.LS in both ischemic and infracted myocardium in CCC group was higher than those in N-CCC group 1month after PCI（P〈0.05）.In addition,the incidence of malignant arrhythmia decreased in CCC group（P〈0.05）.Conclusion CCC can significantly improve the systolic function of ischemic myocardium 72 hafter PCI.The systolic function of ischemic and infracted myocardium and the left ventricular global diastolic function are also improved 1month after PCI.