心肌声学造影超声心动图评估经皮冠状动脉介入治疗后合并2型糖尿病ST段抬高心肌梗死患者心肌功能及微循环

Myocardial contrast echocardiography for evaluating myocardial function and microcirculation after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction complicated with type 2 diabetes mellitus

目的采用心肌声学造影超声心动图(MCE)观察经皮冠状动脉介入治疗(PCI)后ST段抬高型心肌梗死(STEMI)患者心肌功能及心肌灌注血流量,评估2型糖尿病(T2DM)对PCI后STEMI患者心肌功能和微循环的影响。方法纳入65例STEMI患者,根据是否合并T2DM将其分为合并T2DM组(n=42)及单纯STEMI组(n=23);采用常规超声心动图及MCE测量相关指标,比较组间超声参数差异,分析STEMI患者PCI后3个月心肌功能与心肌灌注血流量的相关性。结果65例中,40例(40/65,61.54%)心肌造影分数为1分,25例(25/65,38.46%)为0.5分。合并T2DM组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室舒张末期容积(LVEDV)及左心室收缩末期容积(LVESV)均大于单纯STEMI组(P<0.05),而左心室射血分数(LVEF)、左心室心肌灌注曲线平均斜率(β)及心肌血流量(MBF)均低于单纯STEMI组(P均<0.05)。PCI术后3个月,STEMI患者局部MBF与LVEDD、LVESD、LVEDV、LVESV、左心室每搏量(LVSV)、左心房前后径(LAD)及E/A及E/e’均呈负相关(r=-0.423、-0.383、-0.368、-0.321、-0.321、-0.434、-0.255、-0.239,P均<0.05),而与LVEF呈正相关(r=0.247,P=0.041)。结论MCE可定量评价PCI后STEMI患者心肌微循环;PCI后,相比单纯STEMI患者,合并T2DM者左心室收缩及舒张功能均减低,且心肌微循环功能更差。

Objective To observe the myocardial function and myocardial perfusion blood flow in patients with ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)with myocardial contrast echocardiography(MCE),and to explore the impact of type 2 diabetes mellitus(T2DM)on myocardial function and microcirculation in patients with STEMI after PCI.Methods Totally 65 STEMI patients were enrolled and divided into STEMI complicated T2DM group(T2DM group,n=42)and single STEMI group(n=23).The ultrasonic parameters were compared between groups,and the correlations between myocardial function and myocardial perfusion blood flow in STEMI patients 3 months after PCI were evaluated with conventional echocardiography and MCE.Results Among 65 STEMI patients,myocardial contrast score of 1 was found in 40 cases(40/65,61.54%),while myocardial contrast score of 0.5 was detected in 25 cases(25/65,38.46%)and left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular end diastolic volume(LVEDV)and left ventricular end systolic volume(LVESV)in T2DM group were larger than those in single STEMI group(all P<0.05),while left ventricular ejection fraction(LVEF),average slope of left ventricular myocardial perfusion curve(β)and myocardial blood flow(MBF)were lower than those in single STEMI group(all P<0.05).Three months after PCI,local MBF of STEMI patients was negatively correlated with LVEDD,LVESD,LVEDV,LVESV and left ventricular stroke volume(LVSV)left atrial diameter(LAD)and E/A and E/e’(r=-0.423,-0.383,-0.368,-0.321,-0.321,-0.434,-0.255,-0.239,all P<0.05),but positively correlated with LVEF(r=0.247,P=0.041).Conclusion MCE could be used to quantitatively evaluate myocardial microcirculation in STEMI patients after PCI.Compared with single STEMI patients,those complicated with T2DM had lower left ventricular systolic and diastolic function and worse myocardial microcirculation function.