左心室压力-应变环评估急性心肌梗死患者经皮冠状动脉介入术后心肌收缩功能和灌注水平

Assessment of systolic function and myocardial perfusion after percutaneous coronary intervention in patients with acute myocardial infarction by left ventricular pressure-strain loop

目的应用左心室压力-应变环(PSL)评估急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后左心室收缩功能, 并探讨其对心肌灌注的评估情况。方法选择2020年8-12月于佛山市第一人民医院心血管内科重症监护室已完成PCI治疗的AMI患者47例, 于术后72 h内(T1期)行心肌声学造影(MCE)和超声心动图检查, 并于3个月以后(T2期)复查。获取左心室各节段心肌灌注评分(MPS), 计算整体心肌灌注评分指数(PSI), 并根据PSI将患者分为灌注良好组与灌注不良组;获取常规超声参数、二维左心室整体纵向应变(2D-GLS)及心肌做功参数:整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)。比较术后两组间各参数间的差异, 以及同一组各参数在T1、T2期的差异, 并用ROC曲线分析应变和心肌做功参数对灌注不良的诊断价值。结果灌注良好组与不良组间常规超声参数在T1、T2期差异无统计学意义(均P>0.05), 2D-GLS和心肌做功参数(除T2期GWI)差异有统计学意义(均P<0.05)。T2期两组2D-GLS和心肌做功参数(除GWW)较T1期升高, 差异有统计学意义(均P<0.05), 而GWW差异无统计学意义(P>0.05);灌注良好组GWW T2期较T1期降低, 灌注不良组则相反。ROC曲线分析显示2D-GLS、GWI、GCW、GWE均有较高的曲线下面积。结论 PSL为AMI患者PCI术后心功能的评估提供了新的敏感方法, 且有望成为初步评估AMI患者微循环的新指标。

Objective To evaluate left ventricular systolic function and myocardial perfusion in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)by left ventricular pressure-strain loop(PSL).Methods From August 2020 to December 2020,47 patients with AMI admitted to the Intensive Care Unit of Cardiovascular Department of the First People′s Hospital of Foshan and treated with PCI were selected.Myocardial contrast echocardiography(MCE)and conventional echocardiography were performed within 72 hours after operation(T1 phase)and conventional echocardiography was repeated 3 months later(T2 phase).Myocardial perfusion scores(MPS)of left ventricular segments were obtained by MCE and the overall myocardial perfusion score index(PSI)was calculated.According to PSI,the patients were divided into good perfusion group and poor perfusion group.Conventional ultrasonic parameters and two-dimensional global longitudinal strain(2D-GLS)were collected.Left ventricular PSL analyzed in off-line EchoPAC software was used to evaluate the left ventricular myocardial work index,including global work index(GWI),global constructive work(GCW),global waste work(GWW),global work efficiency(GWE).The differences of parameters between patients with different perfusion levels and the change of parameters with time at the same perfusion level were compared.ROC curves were used to analyze the diagnostic values of strain parameters and myocardial work parameters in patients with hypoperfusion.Results There were no significant differences in conventional ultrasound parameters between groups in T1 and T2 phases(all P>0.05),while there were significant differences in 2D-GLS and myocardial work parameters(except GWI in T2 phase)(all P<0.05).The absolute values of 2D-GLS and myocardial work parameters(except GWW)were higher than those in T1 phase(all P<0.05).There was no significant difference in GWW(P>0.05),but it decreased in good perfusion group while increased in poor perfusion group over time.ROC curve analysis showed that 2D-GLS,GWI,GCW and GWE had high area under the curve.Conclusions Left ventricular PSL provides a new sensitive method for the evaluation of cardiac function in patients with AMI after PCI,and is expected to become a new index for the preliminary evaluation of microcirculation.