摘要
目的应用实时心肌超声造影(MCE)技术评价不同时间窗行冠脉介入术(PCI)治疗后的急性心肌梗死(AMI)患者不同时间段心肌血流灌注对其左心结构和功能改变、临床症状的影响。方法收集2016年6月至2018年6月300例已行冠脉介入治疗的AMI患者,将其分为急诊PCI组、延迟PCI组,分别于术后早期(术后1周内)、术后6个月、术后12个月行实时心肌声学造影检查,将左室壁分为17节段,运用Q-analysis软件进行心肌灌注的定量分析。根据心肌灌注造影结果进行室壁运动评分及MCE半定量评分,应用二维应变软件测量各个节段的收缩期纵向峰值应变,测量并比较左室舒张末期内径(LVDd)、左室射血分数(LVEF)及记录临床症状。结果所有患者均顺利完成MCE,无不良反应发生,其中1 365个节段心肌因透声条件及侧方声影的影响被排除。血运重建术前,MCE评价存活心肌为969节段,无存活心肌为227节段,敏感性、特异性及准确性分别为88.4%、68.7%和87.8%。血运重建术前,二维超声心动图发现共有1 364个室壁明显发生节段性运动异常,其中有1 049个室壁的节段性运动异常,术后得到改善。心肌灌注改善组(1 049个节段)术前心肌收缩期纵向峰值应变明显高于心肌灌注无改善组(315个节段)[(-7.3±5.8)%和(-2.1±1.7)%, P<0.01]。以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值判断心肌梗死时存活心肌的敏感性为72%,特异性为85%。急诊PCI组住院时间明显较延迟PCI组缩短(P<0.05);急诊PCI组LVDd明显小于延迟PCI组(P<0.01)、而LVEF明显高于延迟PCI组(P<0.01)。结论以MCE为评价心肌灌注的方法,可以检测AMI患者PCI后的心肌灌注水平,并分析心肌灌注水平及左室重构的关系。
Objective Real-time myocardial contrast-enhanced(MCE) technique was used to evaluate the effect of clinical symptoms,the changes of left ventricular structure and the function in patients with acute myocardial infarction of coronary heart disease(AMI) after different time windows of coronary intervention in patients with AMI.Methods From June 2016 to June 2018, 300 patients with AMI who had undergone coronary intervention were divided into emergency PCI group and delayed PCI group, respectively, at the early stage of operation(within 1 week after operation) and 6 months after operation. Twelve months after operation, the left ventricular wall was divided into18 segments by real-time contrast echocardiography. The quantitative analysis of myocardial perfusion was performed by Q-analysis software. The left ventricular wall motion score and MCE semi-quantitative score were performed according to the results of myocardial perfusion angiography. The longitudinal peak systolic strain of each segment was measured by two-dimensional strain software, and the left ventricular end-diastolic diameter(LVDd),) was measured and compared. Left ventricular ejection fraction(LVEF) and clinical symptoms were recorded. Results No adverse reaction occurred after successful completion of MCE, in all patients. 1 365 segments of the myocardium were excluded because of the effects of sound transmission condition and lateral sound shadow. Before revascularization, 969 segments of viable myocardium and 227 segments of non-viable myocardium were evaluated by MCE. The sensitivity,specificity and accuracy were 88.4%, 68.7% and 87.8%, respectively. Before revascularization, a total of 1 364 ventricular walls were found to have segmental motion abnormalities, and 1 049 of them were improved after operation.The longitudinal peak systolic strain of myocardial perfusion improved group(1 049 segments) was significantly higher than that of non-improved myocardial perfusion group [(-7.3±5.8)% vs(-2.1±1.7)%, P<0.01]. The sensitivity and specificity
作者
陈火梅
赖玉琼
杨希立
莫展
王飞
吴仰帆
冯柳娜
Chen Huomei;Lai Yuqiong;Yang Xili;Mo Zhan;Wang Fei;Wu Yangfan;Feng Liuna(Echocardiography Room,The First Pople′s Hospital of Foshan Affiliated to Medical College of Zhongshan University,Guangdong 528000,China)
出处
《实用医学影像杂志》
2019年第6期556-560,共5页
Journal of Practical Medical Imaging
关键词
心肌灌注显像
心肌梗死
放射摄影术
介入术
Myocardial perfusion imaging
Myocardial infarction
Radiography,interventional
