心肌声学造影对急性心梗PCI术后心肌灌注的评价

Evaluation on myocardial perfusion after PCI for acute myocardial infarction by myocardial contrast echocardiography

目的:通过心肌声学造影(MCE)对急性心梗经皮冠状动脉支架术(PCI)后心肌灌注的情况进行判断,了解其对左心功能及左室重构的影响。方法:采用病例对照的研究方法,根据PCI术后1周的MCE检查,将急性心梗患者分为灌注正常组、灌注稀疏组和灌注缺失组,并随访检查3个月、6个月的左室射血分数(LVEF)及左室舒张末内径(LVDd)的变化情况,比较组内及组间不同时段LVEF与LVDd的变化。结果:PCI术后3个月灌注稀疏组LVEF恢复到正常;灌注缺损组PCI术后LVEF的平均水平随时间变化而逐渐降低;灌注缺损组患者的LVEF低于灌注稀疏组和灌注正常组(P<0.05);术后6个月灌注缺损组LVDd平均水平高于灌注正常组和灌注稀疏组(P<0.05),灌注缺损组随时间的变化左室内径逐渐增大(P<0.05)。结论:急性心梗患者PCI术后心肌微循环较差时,其左室射血分数降低,左室内径增大;MCE有利于对急性心梗患者PCI术后左心功能及左室重构评估。

Objective:To judge the myocardial perfusion after percutaneous coronary intervention(PCI)for acute myocardial infarction by myocardial contrast echocardiography(MCE)and to understand its impact on left heart function and left ventricular remodeling.Methods:Patients with acute myocardial infarction were divided into the normal perfusion group,the sparse perfusion group,and the perfusion defect group by using a case-control study method and according to the MCE examination 1 week after PCI,the left ventricular ejection fraction was checked 3 months and 6 months after follow-up(LVEF)and the changes of left ventricular end-diastolic diameter(LVDd),LVEF and LVDd at different time within and between groups are compared.Results:The LVEF in the sparse perfusion group returned to normal 3 months after PCI;the average level of LVEF in the perfusion defect group after PCI gradually decreased with time;the LVEF of the perfusion defect group was lower than that of the sparse perfusion group and the normal perfusion group(P<0.05);the average level of LVDd in the perfusion defect group was significantly higher than that of the normal group and the sparse perfusion group 6 months after the operation.The left ventricular diameter gradually increased with time in the perfusion defect group.Conclusion:When the myocardial microcirculation of patients with acute myocardial infarction is poor after PCI,the left ventricular ejection fraction will decrease and the left ventricular diameter will increase;MCE is helpful to evaluating left ventricular function and left ventricular remodeling after PCI in patients with acute myocardial infarction.