超声斑点追踪成像技术评估急性心肌梗死急诊介入治疗前后心功能及心肌力学研究

Application of ultrasonic speckle tracking imaging technique in emergency interventional therapy of acute myocardial infarction

目的:观察超声斑点追踪成像(STI)技术在急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)治疗前后心功能及心肌力学中的评估价值。方法:选择医院收治的102例AMI患者,所有患者均接受PCI治疗,分别于PCI术前即刻、术后1周及术后3个月时行STI检查,对比其治疗前后超声心动图常规参数[左室射血分数(LVEF)、左室收缩末期内径(LVESD)及左室舒张末期内径(LVEDD)],以及左室应变参数[左室整体外层心肌环向应变值(GCS-epi)、中层心肌环向应变值(GCSmid)、内层心肌环向应变值(GCS-endo)、左室整体外层心肌纵向应变值(GLS-epi)、中层心肌纵向应变值(GLS-mid)、内层心肌纵向应变值(GLS-endo)、心尖左室长轴总应变(GLPS-LAX)、四腔总应变(GLPS-A4C)、二腔总应变(GLPSA2C)、左室长轴平均总应变(GLPS-AVG)]。结果:102例AMI患者术后1周及3个月时的LVEF均较术前即刻升高,LVESD及LVEDD均较术前即刻降低,且各时点比较差异有统计学意义(F=153.333,F=121.698,F=142.792;P<0.05),术后1周及3个月时的GCS-epi、GCS-mid及GCS-endo均较术前即刻降低,且各时点比较差异有统计学意义(F=655.563,F=203.876,F=144.250;P<0.05),术后1周及3个月时的GLS-epi、GLS-mid及GLS-endo均较术前即刻降低,且各时点比较差异有统计学意义(F=769.050,F=238.169,F=191.697;P<0.05),术后1周及3个月时GLPS-LAX、GLPS-A4C、GLPS-A2C以及GLPS-AVG均较术前即刻降低,且各时点比较差异有统计学意义(F=769.050,F=238.169,F=191.697,F=185.156;P<0.05)。结论:STI检查可准确评估患者PCI治疗前后的心功能及心肌力学,多时点检测可反馈患者心功能、心肌力学动态变化,为临床评价AMI患者PCI治疗的效果提供依据。

Objective:To observe the assessment value of ultrasonic speckle tracking imaging(STI)technique in cardiac function and myocardial mechanics of patients with acute myocardial infarction(AMI)before and after percutaneous coronary intervention(PCI).Methods:A total of 102 AMI patients who admitted to hospital were selected and all of them received PCI treatment.STI examinations were performed on patients at the moment before PCI,at the 1st week after surgery,and at 3rd month after surgery.The echocardiographic routine parameters[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)]and left ventricular strain parameters[circumferential strain value of the overall outer layer of the left ventricular myocardium(GCS-epi),middle myocardial circumferential strain value(GCS-mid),inner myocardial circumferential strain value(GCS-endo),longitudinal strain value of the overall outer myocardial layer of the left ventricle(GLS-epi),medial myocardial longitudinal strain value(GLS-mid),longitudinal strain value of inner myocardial layer(GLS-endo),total strain of apical left ventricular long axis(GLPS-LAX),total strain of four cavities(GLPS-A4C),total strain of two cavities(GLPS-A2C),left ventricular long axis average total strain(GLPS-AVG)]of patients were further compared.Results:The LVEF of AMI patients at the 1st week and the 3rd month after surgery were significantly higher than that at the moment before surgery,and the LVESD,LVEDD,GCS-epi,GCS-mid,GCS-endo,GLS-epi,GLS-mid,GLS-endo,GLPSLAX,GLPS-A4C,GLPS-A2C and GLPS-AVG at the 1st week and the 3rd month after surgery were significantly lower than those at the moment before surgery,and the differences of each time point intra group were significant(F=153.333,F=121.698,F=142.792,F=655.563,F=203.876,F=144.250,F=769.050,F=238.169,F=191.697,F=769.050,F=238.169,F=191.697,F=185.156,P<0.05),respectively.Conclusion:STI examination can accurately assess the cardiac function and myocardial mechanics of patients before and after PCI treatment,and the dynamic changes of cardiac function and myocardial mechanics of patients can be fed back by multi time point detection,which can provide basis to evaluate the effect of PCI treatment for AMI patients in clinical work.