延迟经皮冠状动脉介入术前心肌灌注预测急性心肌梗死患者心肌收缩功能恢复的价值

Myocardial perfusion before delayed percutaneous coronary intervention is valuable in predicting the systolic function recovery of patients with acute myocardial infarction

目的探讨延迟经皮冠状动脉介入(PCI)术前心肌灌注预测急性心肌梗死(AMI)患者心肌收缩功能恢复的价值。方法选取2014年1月至2015年6月佛山市第一人民医院收治的64例接受延迟PCI治疗的AMI患者。术前1 d应用二维应变成像测量患者左心室各节段心肌收缩期纵向峰值应变(LPSS)及整体收缩期纵向峰值应变(GLS)。应用心肌超声造影(MCE)对患者左心室各节段心肌进行灌注评分(MPS),计算整体心肌灌注评分指数(PSI),并根据MPS将收缩功能受损心肌分为灌注良好组、灌注减少组、灌注缺失组。术后6个月二维应变成像测量患者左心室心肌LPSS及GLS。采用配对t检验比较术前1 d、术后6个月患者左心室心肌GLS、LPSS差异;采用单因素方差分析比较灌注良好组、灌注减少组、灌注缺失组心肌LPSS,进一步组间两两比较采用LSD-t检验;采用Spearman秩相关分析法分析PSI与GLS、MPS与LPSS的相关性。结果术后6个月患者左心室心肌GLS高于术前1 d,且差异均有统计学意义[(-15.39±7.80)%vs(-12.44±8.38)%,t=14.398,P<0.001]。延迟PCI术前1 d灌注缺失组、灌注减少组、灌注良好组心肌LPSS分别为(-2.64±5.60)%、(-6.19±6.87)%、(-12.07±5.86)%,术后6个月分别为(-2.97±4.93)%、(-11.38±7.26)%、(-15.82±5.97)%,术后6个月灌注良好组、灌注减少组心肌LPSS较术前1 d增加,且差异均有统计学意义(t=13.013、10.821,P均<0.001),灌注缺失组心肌LPSS与术前1 d比较差异无统计学意义。术前1 d、术后6个月灌注缺失组、灌注减少组、灌注良好组心肌间LPSS差异均有统计学意义(术前1 d:灌注缺失组vs灌注减少组、灌注良好组,t=4.201、11.771,P均<0.001;灌注减少组vs灌注良好组,t=12.561,P<0.001。术后6个月:灌注缺失组vs灌注减少组、灌注良好组,t=9.714、15.646,P均<0.001;灌注减少组vs灌注良好组,t=9.254,P<0.001),且均为灌注良好组>灌注减少组>灌注缺失组。PSI与术前1 d、术后6个月GLS均有相关性(r=0.69、0.72,P均<0.001),MPS与术前1 d、术后6个月LPSS均有相关性(r=0.49、0.45,P均<0.001)。结论心肌灌注与心肌收缩功能密切相关,应用MCE评估延迟PCI术前患者心肌灌注对术后患者心肌收缩功能恢复具有预测价值。

Objective To evaluated the value of myocardial perfusion before delayed percutaneous coronary intervention （PCI） for predicting the recovery of systolic function of patients with acute myocardial infarction （AMI）. Methods A total of 64 patients with AMI receiving delayed PCI treatment in the First People＇s Hospital of Foshan from January 2014 to June 2015 were selected. One day prior to delayed PCI, all of the patients underwent two dimensional strain to measure the longitudinal peak systolic strain （LPSS） of each left ventricular segment and the global longitudinal strain （GLS） of the left ventricle. The myocardial perfusion score （MPS） and the perfusion score index （PSI） were measured by myocardial contrast echocardiography （MCE）. Left ventricular myocardial perfusions were classified as good, reduced, or absent. The two dimensional strain measurements were again conducted at 6 months after the delayed PCI to assess LPSS and GLS. The change of GLS and LPSS between one day prior to delayed PCI and six months after delayed PCI was assessed by paired t-test. The differences of LPSS among good, reduced, or absent myocardial perfusion groups were analyzed by one-way ANOVA. LSD-t test was used to compare in pairs of groups that had different values. The correlations between PSI and GLS, MPS and LPSS were assessed by Spearman＇s rank-correlation test. Results The GLS of all patients were higher at six months after delayed PCI than at one day prior to delayed PCI [（-15.39±7.80）% vs （-12.44±8.38）%, t=14.398, P 〈 0.001]. The LPSS of myocardial perfusion in good, reduced and absent groups at one day prior to delayed PCI were （-2.64±5.60）%, （-6.19±6.87）% and （-12.07±5.86）%, respectively. The LPSS of myocardial perfusion in good, reduced and absent groups at six months after delayed PCI were （-2.97±4.93）%, （-11.38 ± 7.26）% and （-15.82 ± 5.97）%, respectively. The myocardial LPSS of left ventricular segment with good or reduced perfusion was significantly higher at six months after delayed PCI （t=13.013, 10.821, both P 〈 0.001）, but the LPSS of left ventricular segment with absent perfusion was similar to that of pre-PCI. Whether at one day prior to delayed PCI or six months after delayed PCI, there were significant differences in LPSS parameters among the three groups （at one day prior to delayed PCI, myocardial perfusion absent vs reduced or good, t=4.201 and 11.771, both P 〈 0.001; myocardial perfusion reduced vs good, t=12.561, P 〈 0.001; at six months after delayed PCI, myocardial perfusion absent vs reduced or good, t=9.714 and 15.646, both P 〈 0.001; myocardial perfusion reduced vs good, t=9.254, P 〈 0.001）. The LPSS both at one day prior to delayed PCI and six months after delayed PCI in myocardial perfusion good group 〉 those of myocardial perfusion reduced group 〉 those of myocardial perfusion absent group. PSI was positively correlated with GLS at both one day prior to delayed PCI and six months after delayed PCI （r=0.69, 0.72, both P 〈 0.001）. MPS was positively correlated with LPSS at both one day prior to delayed PCI and six months after delayed PCI （r=0.49 and 0.45, both P 〈 0.001）. Conclusion Myocardial perfusion before delayed PCI, monitored by MCE, is correlated well with myocardial systolic function, and may be used to predict the recovery of myocardial systolic function after delayed PCI.