定量组织速度成像评价急性心肌梗死后不同时段左心室功能

Evaluation on left ventricular function in different periods after acute myocardial infarction by quantitative tissue velocity imaging

目的:应用定量组织速度成像技术对急性心肌梗死后不同时段的二尖瓣环运动进行检测,探讨定量组织速度成像评价再灌注治疗急性心肌梗死疗效的临床应用价值。方法:对60例初次急性前壁心肌梗死患者(心梗后再灌注治疗28例,未再灌注治疗32例)和年龄匹配的健康人25例应用定量组织速度成像技术分别测量、计算二尖瓣环的收缩期、舒张早期和舒张中晚期平均峰值运动速度(Vs,Ve,Va)。测量左室射血分数(LVEF)、左室短轴缩短率(FS)和二尖瓣血流速度(E,A),LVEF采用Simpson's原理。急性心肌梗死患者分别于发病后第2周、4周、12周进行上述测量。比较分析再灌注治疗对急性心肌梗死患者左室功能的短期影响。结果:再灌注组12周死亡率为0,未再通组12周死亡率为15.6%。Vs与LVEF呈显著正相关(r=0.76,P<0.01);Ve/Va与二尖瓣口血流速度E/A显著正相关(r=0.68,P<0.01)。急性心肌梗死患者发病后第2,4,12周Vs,Ve,Va,LVEF,FS,Ve/Va,E/A均低于对照组(P<0.05～0.01);再灌注组2,4,12周Vs,Ve,LVEF,FS,Ve/Va均显著优于未再灌注组(P<0.05～0.01);再灌注组4,12周Vs,Ve,LVEF,FS,Ve/Va与2周时比较有显著改善(P<0.05～0.01);未再灌注组12周Vs,Ve,LVEF,FS与2周时比较有显著改善(P均<0.05),而4周与2周时比较无显著差异(P>0.05)。结论:QTVI测量二尖?

AIM:To assess the effect of quantitative tissue velocity imaging(QTVI) on mitral annulus velocity at different periods after acute myocardial infarction(AMI),and to explore the clinical effect of reperfusion therapy on AMI by using QTVI. METHODS:Sixty patients with AMI for the first time(28 patients reperfused after AMI and 32 patients not reperfused) and another 25 normal subjects were studied by QTVI.The average peak velocities of mitral annulus systole, early diastole and late diastole were acquired(Vs,Ve,Va).Left ventricular ejection fraction(LVEF),fractional shortening(FS),E and A were measured, and LVEF were determined by using Simpson's rule.The patients were studied at 2nd,4th and 12th week after AMI,then the limited period effect on the left ventricular function of reperfusion therapy on AMI was compared and analyzed. RESULTS:The death rates at 12th week in the reperfusion group and non reperfusion group were 0 and 15.6% respectively.There was positive relation between Vs and LVEF( r=0.76,P< 0.01) ;and the relation between Ve/Va and E/A was also positive( r=0.68,P< 0.01) .Compared with the control group,The Vs,Ve,Va,LVEF,FS,Ve/Va and E/A of AMI patients at 2nd week,4th week and 12th week after AMI were all significantly lower than those in the control group(P< 0.05- 0.01).While Vs, Ve,LVEF,FS,Ve/Va in the reperfusion group at 2nd week,4th week and 12th week were significantly higher than those in the non reperfusion group(P< 0.05- 0.01).In the reperfusion group,Vs,Ve,LVEF,FS and Ve/Va at 4th week and 12th week were significant different from those at 2nd week (P< 0.05- 0.01).In the non reperfusion group,Vs,Ve,LVEF and FS at 12th week were significantly different from those at 2nd week(P >0.05), while those at 2nd and 4th week had no difference. CONCLUSION:The mitral annulus average peak velocities determined by QTVI can well reflect the global systolic and diastolic function of left ventricular,so it can be used to assess the effect of reperfusion therapy on the left ventricular function in patients with AMI.Prompt and effective reperfusion therapy cannot only raise the survival rate,but also improve the left ventricular function.