二维超声心动图联合M型超声对检测非ST段抬高型心肌梗死室壁运动异常的评估

Assessment of Wall Motion Abnormalities by Non-ST-Segment Elevation Myocardial Infarction with Two-Dimensional Echocardiography and M-Mode Ultrasound

目的探讨二维超声心动图(2DE)联合M型超声对非ST段抬高型心肌梗死(NSTEMI)室壁运动异常的评估价值。方法选取我院收治的122例NSTEMI患者为研究对象。所有患者首先接受2DE超声检查,对于2DE左心室节段室壁运动异常(2DE-RWMA)阳性的患者联合M型超声检查。最后,所有NSTEMI患者接受冠状动脉造影(CAG)检查。CAG检查在超声心动图后48小时内完成。结果 2DE-RWMA能够检出约53.57%冠状动脉病变,漏诊率约46.43%。2DE-RWMA阳性对三支冠状动脉受累的NSTEMI检出率显著高于三支以下受累的NSTEMI患者(P<0.05);2DE-RWMA对冠状动脉狭窄≥90%的检出率显著高于狭窄程度<90%的NSTEMI患者(P<0.05);2DERWMA对NSTEMI的检出率与受累冠状动脉数量和冠状动脉狭窄程度均呈正比(P<0.05);2DE-RWMA阳性患者经M型超声检查发现,WTF-RWMA阳性者左室室壁节段运动幅度和各节段室壁收缩期增厚率明显增加(均P<0.05)。结论 2DE联合M型超声能够敏感地发现NSTEMI引起的心肌缺血和左心室室壁运动异常,显著提高NSTEMI的早期检出率。

Objective To assess the value of two-dimensional echocardiography（ 2 DE） combined with M-mode ultrasound in evaluating the wall motion abnormality of non-ST-segment elevation myocardial infarction（ NSTEMI）. Methods 122 patients with NSTEMI admitted to our hospital were selected as study subjects. Firstly,patients with NSTEMI underwent the examination of 2 DE ultrasonography; patients with positive regional wall motion abnormality（ 2 DE-RWMA） were combined with Mmode ultrasound. All NSTEMI patients also underwent coronary angiography（ CAG） examination. The CAG examination was performed within 48 hours after the echocardiogram. Results 2 DE-RWMA could detect about 53. 57% of coronary artery lesions,and the missed diagnosis rate was about 46. 43%. The detection rate of 2 DE-RWMA positive for NSTEMI in three coronary artery lesions was significantly higher than that in NSTEMI（ P 0. 05）. The detection rate of 2 DE-RWMA in coronary artery stenosis greater than or equal to 90% was significantly higher than that of NSTEMI in which the degree of stenosis was less than 90%（ P 0. 05）. The detection rate of NDEEMI by 2 DE-RWMA was positively correlated with the number of involved coronary arteries and coronary artery stenosis（ P 0. 05）. In 2 DE-RWMA-negative patients,M-mode ultrasonography revealed that the left ventricular wall motion amplitude and systolic thickening rate of each segment of wall thickening rate（ WTF）-RWMA-positive patients were significantly increased（ all P 0. 05）. Conclusions 2 DE combined with M-mode ultrasound can sensitively detect NSTEMI-induced myocardial ischemia and left ventricular wall motion abnormalities,and significantly increase the early detection rate of NSTEMI.