实时三维超声心动图对多支冠脉病变患者左心室重构研究

Left Ventricular Remodeling in Patients with Multivessel Coronary Artery Disease by Real-time Three-dimensional Echocardiography

目的:采用实时三维超声心动图(RT-3DE)评估不同支数冠状动脉病变患者左室重构心功能参数,探讨左室重构程度与冠状动脉病变支数的关系。方法:对32例冠心病患者及15例正常人按冠脉造影结果分为正常对照组、单支病变组、双支病变组、三支病变组4组,采用实时三维超声心动图测量各组中的左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、左心室射血分数(LVEF)、左心室心肌质量(LVM)、左心室重构指数(LVRI)数值,与冠脉造影结果进行相关性分析。结果:冠心病实验分组中的LVEF、LVRI小于对照组(P<0.01),LVESV、LVEDV大于对照组(P<0.05或<0.01),LVM与病变支数无良好相关性(P>0.05);随着冠心病患者堵塞支数的增多,LVEDV、LVESV进行性增大(P<0.05或<0.01),LVRI、LVEF进行性减小(P<0.01),LVM无明显变化,LVEDV、LVESV、LVEF及LVRI与冠脉病变支数均有较好的相关性(P<0.01)。结论:冠心病患者的重构严重程度随着冠状动脉病变支数增多而加重,实时三维超声心动图不仅能够评价不同支数冠心病患者左室重构,且左心室重构指数(LVRI)可作为评估左室重构的新方法。

Objective： To evaluate the left ventricular remodeling in patients with different coronary artery lesions by realtime three-dimensional echocardiography（RT-3DE）,and to investigate the relationship between left ventricular remodeling and the number of coronary artery lesions.Methods： According to the results of coronary angiography,15 normal subjects and 32 patients with coronary heart disease were divided into 4 groups： normal control group,single vessel disease group,double-branch disease group and three-branch disease group.Real-time three dimensional echocardiography was used to measure left ventricular figure in end systolic volume（LVESV）,left ventricular end diastolic volume（LVEDV）,left ventricular ejection fraction（LVEF）,left ventricular mass（LVM）,left ventricular remodeling index（LVRI） and left ventricular remodeling index of each group.Correlation analysis was made with the results of coronary angiography.Results： LVEF and LVRI in the group of coronary heart disease were less than that of the control group（P 〈 0.01）.LVESV and LVEDV in the group of patients with coronary heart disease were higher than those in normal control group（P 〈 0.05 or 0.01）; LVM and lesion count had no good correlation（P 〉 0.05）.With the increase of the number of blockage in patients with coronary heart disease,LVEDV and LVESV were progressively enlarged（P 〈 0.05 or P 〈 0.01）; LVRI and LVEF decreased gradually（P 〈 0.01）.There was no significant change in LVM.LVEDV,LVESV,LVEF and LVRI were correlated with the number of coronary lesions（P 〈 0.01）.Conclusion： The severity of remodeling in patients with coronary artery disease is aggravated with the increase of the number of coronary artery lesions.Real-time three-dimensional echocardiography can evaluate left ventricular remodeling in patients with different number of coronary heart disease.Left ventricular remodeling index（LVRI） can be used to evaluate left ventricular remodeling as a new method.