【摘要】 目的探讨二维斑点追踪成像(2D-STI)联合实时三维超声心动图(RT-3DE)在评估急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后左室功能变化中的价值。方法选取急性心肌梗死拟行PCI术的患者30例,于术前、术后1周和1个月使用2D-STI和RT-3DE评估左室功能和同步性。2D-STI测量左室功能指标包括左室基底段、心尖段、中间段的纵向应变(LS)和左室整体纵向应变(GLS),同步性指标包括18个节段达峰时间的最大-最小值差(Tp-diff)和标准差(Tp-SD);RT-3DE测量左室功能指标包括基底段、中间段、心尖段射血分数(EFbase、EFmiddle、EFapex)和左室射血分数(LVEF),同步性指标包括16节段达最小收缩期容积时间的最大-最小值差(Tmsv-16-diff)和标准差(Tmsv-16-SD),以及两参数经RR间期校正后占心动周期的百分比值(Tmsv-16-diff%、Tmsv-16-SD%)。绘制受试者工作特征(ROC)曲线分析2D-STI、RT-3DE单独及联合应用对左室内不同步的诊断效能。结果 2D-STI检查结果显示,急性心肌梗死患者术后GLS、基底段LS、心尖段LS和中间段LS均逐渐上升,术后1个月与术后1周比较差异均有统计学意义(均P<0.05);Tp-diff和Tp-SD逐渐下降,术后1周与术前和术后1个月比较差异均有统计学意义(均P<0.05)。RT-3DE检查结果显示,急性心肌梗死患者术后LVEF、EFbase、EFmiddle及EFapex均逐渐上升,术后1个月与术后1周比较差异均有统计学意义(均P<0.05);Tmsv-16-diff、Tmsv-16-SD、Tmsv-16-diff%及Tmsv-16-SD%均逐渐下降,Tmsv-16-diff和Tmsv-16-diff%术后1周与术前比较、术后1个月与术后1周比较差异均有统计学意义(均P<0.05),Tmsv-16-SD和Tmsv-16-SD%术后1个月与术后1周比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,Tp-diff和Tmsv-16-diff单独诊断左室内不同步的曲线下面积分别为0.869和0.878,敏感性分别为91.35%和92.24%,特异性分别为79.23%和76.67%;两者联合应用的敏感性为96.88%,特异性为81.35%,曲线下面积为0.968,明显高于其单独诊断(Z=4.945,P<0.05)。结论 2D-STI联合RT-3DE可有效评估急性心肌梗死患者PCI术后左室舒缩功能和同步性,对患者临床治疗具有重要指导作用。更多还原

【Abstract】 Objective To investigate the value of two-dimensional speckle tracking imaging(2D-STI) combined with real time three-dimensional echocardiography(RT-3DE) in evaluating left ventricular function after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction.Methods A retrospective analysis of 30 patients with acute myocardial infarction underwent PCI was performed.Left ventricular function and synchrony were evaluated by 2D-STI and RT-3DE before treatment,1 week and 1 month after operation.The 2D-STI left ventricular function indexes included the longitudinal strain(LS) of the left ventricular basal,apical,and middle segments,the left ventricular global longitudinal strain(GLS),and the synchronization indexes included the maximum-minimum difference of the peak time of the 18 segments(Tp-diff) and standard deviation(Tp-SD).RT-3DE left ventricular function indexes included basal segment,middle segment,apical segment ejection fraction(EFbase,EFmiddle,EFapex) and left ventricular ejection fraction(LVEF),and the synchronicity indexes included the time at which 16 segments reach the minimum systolic volume maximum-minimum difference(Tmsv-16-diff) and standard deviation(Tmsv-16-SD),and the percentage of the two cardiac cycles after correction by RR interval(Tmsv-16-diff%,Tmsv-16-SD%).ROC curve was drawn to analyze the diagnostic efficiency of 2D-STI,RT-3DE and their combination in left ventricular asynchromy.Results The results of 2D-STI showed that the GLS,basal segment LS,apical segment LS and middle segment LS were gradually increased,and the difference between 1 month and 1 week after operation were statistically significant(all P<0.05).The Tp-diff and Tp-SD were decreased,and the differences were statistically significant between 1 week after operation and before operation,and between 1 month and 1 week after operation(both P<0.05).The results of RT-3DE showed that the LVEF,EFbase,EFmiddle and EFapex were gradually increased,and the difference between 1 month and 1 week after operation were statistically significant(all P<0.05).The Tmsv-16-diff,Tmsv-16-SD,Tmsv-16-diff% and Tmsv-16-SD% were gradually decreased,the differences of Tmsv-16-diff,Tmsv-16-diff% were statistically significant between 1 week after operation and before operation,and between 1 month and 1 week after operation(both P<0.05).The differences of Tmsv-16-SD,Tmsv-16-SD% were statistically significant between 1 month and 1 week after operation(both P<0.05).ROC curve analysis showed that the area under the curve of 2D-STI and RT-3DE in diagnosis of left ventricular synchronization were 0.869 and 0.878,the sensitivity were 91.35% and 92.24%,and the specificity were 79.23% and 76.67%,respectively.The sensitivity and specificity of the combined application were 96.88% and 81.35%,the area under the curve was0.968,which was higher than that of 2D-STI and RT-3DE(Z=4.945,P<0.05).Conclusion 2D-STI combined with RT-3DE can assess left ventricular systolic and synchrony in patients with acute myocardial infarction,and plays an important guiding role in clinical treatment.更多还原