二维斑点追踪技术评价急性心肌梗死合并心力衰竭患者主动脉球囊反搏治疗前后左心室收缩功能变化

Two-dimensional speckle tracking echocardiography in evaluating left ventricular systolic function before and after intra-aortic balloon pump in patients with acute myocardial infarction and heart failure

目的观察急性心肌梗死合并心力衰竭患者主动脉球囊反搏(intra-aortic balloon pump,IABP)治疗前、后左心室收缩功能变化,探讨二维斑点追踪技术评价IABP治疗效果的应用价值。方法33例急性心肌梗死合并心力衰竭患者均采用IABP治疗。应用二维斑点追踪技术检测治疗前、后左心室整体收缩期纵向峰值应变(global longitudinal peak strain,GLS),包括四腔观GLS、三腔观GLS、两腔观GLS、平均GLS和左心室峰值纵向应变离散度;比较治疗前、后左心室舒张末期容积、左心室收缩末期容积、左心室搏出量、左室射血分数。结果IABP治疗后,33例患者左室射血分数[(43.27±10.71)%]、四腔观GLS[(9.53±3.87)%]、三腔观GLS[(9.41±4.30)%]、两腔观GLS[(9.60±3.32)%]、平均GLS[(9.00±3.60)%]均高于治疗前[(37.03±12.95)%、(7.28±3.21)%、(6.81±2.99)%、(7.35±3.15)%、(7.15±2.77)%](P<0.05),左心室峰值纵向应变离散度[(58.12±19.89)s]低于治疗前[(75.27±26.85)s](P<0.05),左心室舒张末期容积[(114.03±30.61)mL]、左心室搏出量[(48.48±16.33)mL]和左心室收缩末期容积[(65.42±25.15)mL]与治疗前[(113.76±31.77)、(40.94±17.68)、(72.88±29.67)mL]比较差异均无统计学意义(P>0.05)。结论IABP可改善急性心肌梗死合并心力衰竭患者左心室收缩功能。左心室整体收缩期GLS及峰值应变离散度可为临床评价IABP治疗效果提供客观依据。

Objective To observe the changes of left ventricular systolic function before and after intra-aortic balloon pump(IABP)in patients with acute myocardial infarction and heart failure and to investigate the value of two-dimensional speckle tracking echocardiography to the evaluation of the effect of IABP.Methods Thirty-three patients with acute myocardial infarction and heart failure underwent IABP.Two-dimensional speckle tracking echocardiography was used to detect the global longitudinal peak strain(GLS)of the left ventricle before and after IABP:including four-chamber GLS,three-chamber GLS,two-chamber GLS,average GLS and left ventricular longitudinal peak strain dispersion(PSD).The left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular stroke volume,and left ventricular ejection fraction were measured before and after IABP.Results After IABP in 33 patients,the left ventricular ejection fraction((43.27±10.71)%),four-chamber GLS((9.53±3.87)%),three-chamber GLS((9.41±4.30)%),two-chamber GLS((9.60±3.32)%)and average GLS((9.00±3.60)%)were higher than those before IABP((37.03±12.95)%,(7.28±3.21)%,(6.81±2.99)%,(7.35±3.15)%,(7.15±2.77)%)(P<0.05),left ventricular PSD((58.12±19.89)s)was lower than that before IABP((75.27±26.85)s)(P<0.05),and left ventricular end-diastolic volume((114.03±30.61)mL vs.(113.76±31.77)mL),left ventricular stroke volume((48.48±16.33)mL vs.(40.94±17.68)mL)and left ventricular end-systolic volume((65.42±25.15)mL vs.(72.88±29.67)mL)showed no significant differences before and after IABP(P>0.05).Conclusion IABP can improve the left ventricular systolic function in patients with acute myocardial infarction and heart failure.Left ventricular global systolic GLS and PSD can provide objective bases for clinical evaluation of IABP outcome.