AMI患者PCI术后碎裂QRS波、超声心动图及2D-STI参数的变化

Changes of Fragmented QRS Wave,Echocardiography and 2D-STI Parameters in Patients with AMI after PCI

本研究探讨急性心肌梗死(AMI)患者心电图中碎裂QRS波、超声心动图、二维斑点追踪(2D-STI)检测指标与左心重构的关系。选取确诊为AMI并采取经皮冠脉介入术(PCI)治疗的113例患者进行临床研究,根据患者PCI术后12个月内是否发生左心室重构分为重构组(41例)和非重构组(72例)。对比两组患者入院时的动态心电图碎裂QRS波情况、PCI术后6个月的超声心动图、2D-STI指标,并采用Logistic回归模型分析上述指标与患者发生左心室重构的关系。重构组的碎裂QRS波阳性率高于非重构组(P<0.05);重构组的左心室舒张末期容积(LVEDV)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)测定值均高于非重构组(P<0.05);重构组的左室射血分数(LVEF)、左心室收缩末期容积(LVESV)测定值均低于非重构组(P<0.05);重构组的整体圆周应变(CS)、整体径向应变(RS)、纵向应变(LS)测定值均低于非重构组(P<0.05);合并高血压、冠脉病变支数≥3支、IVST增大、LVPWT增大、碎裂QRS波阳性与AMI患者PCI术后发生左心重构呈正相关(P<0.05);LVEF、CS、RS、LS测定值与AMI患者PCI术后发生左心重构呈负相关(P<0.05)。AMI患者PCI术后进行心电图、超声心动图及2D-STI观察对评价患者术后是否出现左心重构具有一定的临床价值。

This study investigated the relationship between fragmented QRS complex in electrocardiogram,echocardiography,two-dimensional speckle tracking(2D-STI)and left ventricular remodeling in patients with acute myocardial infarction(AMI).A total of 113 patients who were diagnosed with AMI and received percutaneous coronary intervention(PCI)were selected for clinical research.According to whether the patients had left ventricular remodeling within 12 months after PCI,they were divided into a remodeling group of 41 cases and a non-remodeling group of 72 cases.The dynamic electrocardiogram fragmentation QRS complex at admission,echocardiogram and 2D-STI indexes at 6 months after PCI were compared between the two groups,and the relationship between the above indexes and left ventricular remodeling was analyzed by Logistic regression model.The positive rate of fragmented QRS complex in the remodeling group was higher than that in the non-remodeling group(P<0.05).The measured values of left ventricular end-diastolic volume(LVEDV),interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWT)in the remodeling group were significantly higher than those in the non-remodeling group(P<0.05).The measured values of left ventricular ejection fraction(LVEF)and left ventricular end-systolic volume(LVESV)in the remodeling group were lower than those in the non-remodeling group.The measured values of overall circumferential strain(CS),overall radial strain(RS),and longitudinal strain(LS)in the remodeling group were lower than those in the non-remodeling group(P<0.05).Complicated hypertension,coronary artery disease branch number≥3,increased IVST,increased LVPWT,and positive fragmented QRS complex were positively correlated with left ventricular remodeling in patients with AMI after PCI(P<0.05).The LVEF,CS,RS,LS measured values were negatively correlated with left ventricular remodeling in patients with AMI after PCI(P<0.05).Observation of ECG,echocardiography and 2D-STI after PCI in patients with AMI has certain clinical value in evaluating whether patients have left ventricular remodeling after operation.