缺血性二尖瓣反流患者冠状动脉介入治疗术前后的超声定量分析

Echocardiographic comparison of ischemic mitral regurgitation before and after percutaneous coronary intervention

目的应用二维斑点追踪成像技术评价缺血性二尖瓣反流(IMR)患者冠状动脉介入治疗术前后左室心肌功能及二尖瓣反流容积的变化。方法选取亚急性心肌梗死患者41例,所有患者于冠状动脉介入治疗术前72 h内及术后6个月采集超声图像,并进行二尖瓣反流容积定量和心肌应变定量分析。根据二尖瓣反流容积变化情况将41例患者分为非恶化组(Ⅰ组)和恶化组(Ⅱ组),对比分析两组术前、术后超声检测情况。结果 41例患者分别为Ⅰ组28例和Ⅱ组13例。Ⅰ组患者术后二尖瓣反流容积较术前明显减少,左室射血分数较术前升高(P<0.05);各节段及总体径向应变、纵向应变均较术前改善(均P<0.05)。Ⅱ组患者术后二尖瓣反流容积较术前增加(P<0.05),左室射血分数较术前升高不明显,差异无统计学意义;短轴基底段径向应变较术前恶化(P<0.05)。结论二维斑点追踪成像技术可以较敏感地评价左室心肌功能;冠状动脉介入治疗术通过改善左室收缩功能可以减少IMR的发生。

Objective To assess the variation of left ventricular function and ischemic mitral regurgitation （IMR） volume before and after percutaneous coronary intervention （PCI） by echocardiography. Methods Forty-one subacute myocardial infarction patients who were prepared to undergo PCI were enrolled. The left ventricular function and IMR were evaluated 72 h before PCT and 6 months after PCI by echocardiography.Then the patients were divided into two groups by the variation of mitral regurgitation volume （ group Ⅰ：IMR volume diminish or increase less than 15 ml; group Ⅱ ：IMR volume increase more than or equal to 15 ml）. Results In 41 patients,there were 28 cases of group Ⅰ ,and 13 cases of group n. In group Ⅰ, the IMR volume decreased and the left ventricular ejection fraction （LVEF） increased after PCI （P〈0.05）, and the regional and global radial strain, longitudinal strain were better than preoperative status（ all P〈0.05 ）.In group Ⅱ, the IMR volume increased PCI（ P〈0.05 ）, the LVEF had no significant improvement, the postoperative basal regional radial strain was worse compared to preoperative status （P〈0.05）.Conclusion Echocardiography can evaluate left ventricular muscle function sensitively.PCI can help reduce IMR by improving left ventricular systolic function.