斑点追踪超声心动图在评价急性心肌梗死并接受延迟经皮冠状动脉介入治疗后发生左心室重构的价值

发布时间：2018-02-25 22:26

本文关键词： 超声心动描记术心肌梗死心室重构　出处：《中国循环杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:评价斑点追踪超声心动图(STE)判断急性ST段抬高型心肌梗死(STEMI)并接受择期经皮冠状动脉介入治疗(PCI)患者是否发生左心室重构的价值。方法:共入选127例首次STEMI并接受择期PCI的患者,入院后48 h内行超声心动图检查。出院后随访6~9个月(中位数为7.8个月),复查超声心动图,左心室重构的定义为左心室收缩末期容积较初次测量增加15%。根据127例患者是否发生左心室重构分为两组,41例发生左心室重构患者为左心室重构组,另86例患者为无左心室重构组。结果:左心室重构组和无左心室重构组两组间比较,左心室壁总体纵向应变、纵向应变达峰时间标准差(Ts-SD)、径向应变、纵向左心室收缩后收缩指数等均有显著差异。进一步Logistic回归分析表明,总体纵向应变[比值比(OR)=0.39,95%可信区间(CI):0.26~0.57,P0.01]及径向应变(OR=1.07,95%CI:1.02~1.13,P=0.01)是预测STEMI并接受择期PCI的患者发生左心室重构的独立预测因素,受试者工作特征(ROC)曲线分析显示二者的最佳界值分别为-10.85%(敏感性:89.7%,特异性:91.7%)及28.46%(敏感性:82.1%,特异性:66.7%)。结论:应用STE获得的左心室壁总体纵向应变及径向应变等是预测STEMI并行择期PCI后发生左心室重构的独立相关因素。
[Abstract]:Objective: to evaluate the value of dot-tracing echocardiography (STE) in judging whether left ventricular remodeling occurred in patients with acute ST-segment elevation myocardial infarction (STEMI) and undergoing selective percutaneous coronary intervention (PCI). Methods: 127 patients with acute ST-segment elevation myocardial infarction (STEMI) were enrolled for the first time. Patients with STEMI who received elective PCI, Echocardiography was performed within 48 hours after admission and followed up for 6 to 9 months (median 7.8 months) after discharge. Left ventricular remodeling is defined as the increase of left ventricular end-systolic volume by 15 percent over the initial measurement. According to whether 127 patients have left ventricular remodeling, they are divided into two groups: 41 patients with left ventricular remodeling. Results: the left ventricular remodeling group and the left ventricular remodeling group were compared. The total longitudinal strain of left ventricular wall, the standard deviation of peak time of longitudinal strain and radial strain were compared between the left ventricular remodeling group and the left ventricular remodeling group. There were significant differences in longitudinal left ventricular systolic index after contraction. Further Logistic regression analysis showed that, The overall longitudinal strain [ratio of 0.39% 95% confidence interval] and the radial strain ratio of 1.07% to 1.13% P0.01 were independent predictors of left ventricular remodeling in patients with STEMI and accepted selective PCI. The analysis of the operating characteristics of the subjects showed that the optimum boundary values of the two were -10.85 (sensitivity 89.7, specificity 91.7) and 28.4646 (sensitivity 82.1 and specificity: 66.7) respectively. Conclusion: the total longitudinal and radial strain of left ventricular wall obtained by STE are preconditioned. Independent factors related to left ventricular remodeling after STEMI combined with selective PCI.
【作者单位】：大连医科大学附属第二医院重症监护室;大连医科大学附属第一医院心血管病院;
【基金】：大连市科技计划项目(2014E14SF173)
【分类号】：R540.45;R542.22

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