心肌声学造影评估急性心肌梗死患者PCI术后心肌微循环改变的临床价值

Clinical value of myocardial contrast echocardiography in evaluating myocardial microcirculation changes after PCI in patients with acute myocardial infarction

目的:探讨心肌声学造影(MCE)评估急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后心肌微循环改变的临床价值。方法:选取120例行PCI治疗的AMI患者为AMI组,同期100名体检健康志愿者为对照组,均行常规超声心动图及MCE检查。比较两组对象及AMI组患者术前、术后3个月常规超声心动图参数[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)]、MCE参数[A值(心肌血容量)、β值(心肌血流速度)和A×β值(心肌血流量)];分析AMI患者MCE参数与LVEF的关系。结果:与对照组比较,AMI组患者LVEDD、LVESD、LVEDV、LVESV增大(P<0.05);左室射血分数(LVEF)降低(P<0.05)。与术前比较,AMI患者术后3个月LVEDV、LVESV变小(P<0.05),但大于对照组(P<0.05);LVEF增大(P<0.05),但小于对照组(P<0.05);LVEDD、LVESD变化无统计学差异(P>0.05)。与对照组比较,AMI患者室间隔和左室游离壁A值、β值和A×β值均降低(P<0.05)。与术前比较,AIM患者术后3个月时室间隔和左室游离壁的A值改变无统计学差异(P>0.05);β值和A×β值均升高(P<0.05),但低于对照组(P<0.05)。相关分析显示,AMI患者术前及术后3个月β值和A×β值均与LVEF正相关(r=0.312、0.345;0.341、0.362,P<0.05)。结论:AMI患者PCI治疗后心肌微循环灌注明显改善,MCE检测PCI后心肌微循环改变,有助于病情和治疗效果的全面评估。

Objective:To investigate the clinical value of myocardial contrast echocardiography(MCE)in evaluating myocardial microcirculation changes after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods:120 AMI patients treated by PCI were selected as the AMI group,and 100 healthy volunteers were selected as the control group at the same time.All of them underwent routine echocardiography and MCE examination.The routine echocardiography parameters[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)],MCE parameters(A value(representing myocardial blood volume),βvalue(representing myocardial blood flow velocity)and A×βvalue(representing myocardial blood flow)]were compared before and 3 months after operation between the two groups and patients in AMI group.Results:Compared with the control group,the LVEDD,LVESD,LVEDV and LVESV of AMI patients were increased(P<0.05),while the LVEF was decreased(P<0.05).Compared with before operation,LVEDV and LVESV in AMI patients decreased significantly 3 months after operation(P<0.05),but were still higher than those in control group(P<0.05).LVEF increased significantly 3 months after operation(P<0.05),but was still lower than that in control group(P<0.05).There was no significant change in LVEDD and LVESD after operation(P>0.05).Compared with control group,the A,βand A×βinterventricular septum and left ventricular free wall in AMI group were significantly decreased(P<0.05).Compared with before operation,the A value of ventricular septum and left ventricular free wall did not change significantly in AIM patients at 3 months after operation(P>0.05),and theβvalue and A×βwere significantly increased(P<0.05),but still lower than those in the control group(P<0.05).Pearson correlation analysis showed that preoperativeβand A×βvalues were positively correlated with LVEF(r=0.312,0.345,P<0.05),andβand A×βvalues 3 months after operation were also positively correlated with LVEF(r=0.341,0.362,P<0.05).Conclusion:The myocardial microcirculation perfusion of AMI patients after PCI is significantly improved.The application of MCE to detect the changes of myocardial microcirculation in AMI patients after PCI is helpful for the comprehensive evaluation of the condition and treatment effect.