实时三维超声心动图对急性心肌梗死介入治疗后左室重构的评价

发布时间：2018-12-18 16:11

【摘要】：目的：利用实时三维超声心动图(RT-3DE)定量分析急性心肌梗死（AMI）患者PCI术后左室舒缩功能、左室收缩同步性，评价左室重构的变化。方法：对63例急性心肌梗死PCI术后患者（A组）及38例健康者（B组）行二维超声心动图（2DE）、RT-3DE检查。1、用二维simpson法和RT-3DE测量A、B两组左室整体收缩功能：左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室射血分数(LVEF)，比较二者测量方法的差异。2、应用RT-3DE测量A、B两组节段收缩功能（rEDV、rESV、rEF）、节段最大射血速率与最大充盈速率（rPER、rPFR）、以及左室收缩同步性指标：左室16节段至最小收缩末容量时间最大差值与标准差及其所在心动周期的百分比（Tmsvl6-Dif、Tmsvl6-Dif%、Tmsvl6-SD、Tmsvl6-SD%），比较两组各参数的差异，，并将心梗组EF与左室收缩同步性参数进行相关性分析。3、比较心梗组PCI术后1周内、术后3个月、术后6个月梗死相关节段的参数变化以。4、另选取10名志愿者（C组）同时（24小时内）行RT-3DE、心脏磁共振（CMRI）检查，采用线性回归及Bland-Altman分析评价RT-3DE与CMRI所测EDV、ESV及EF值的相关性、一致性。结果：1、Simpson法与RT-3DE测得A组EDV、ESV、EF值差别有显著性（P＜0.05），B组EDV、ESV、EF值差别无显著性（P＞0.05）。 2、A组梗死相关节段容积参数（rEDV、rESV）及左室收缩同步性参数（Tmsv-16-Dif、Tmsv-16-Dif%、Tmsv-16-SD、Tmsv-16-SD%）大于B组（P＜0.05），节段舒缩功能参数（rPER、rPFR、rEF）小于B组（P＜0.05)，A组EF与左室收缩同步性参数呈负相关。 3、A组梗死相关节段术后3个月时，节段容积及左室收缩同步性参数小于术后1周内，节段舒缩功能参数大于术后1周内（P＜0.05）；术后6个月上述参数与术后3个月相比差异不明显（P＞0.05）。 4、冠脉血管开通时间小于6小时与大于6小时两亚组比较：术后1周内大于6小时组EDV、ESV较小于6小时组明显增大（P＜0.05），而Tmsv-16-Dif%、Tmsv-16-SD%差异不明显（P＞0.05）；术后3个月小于6小时组Tmsv-16-Dif%、Tmsv-16-SD%较前明显减小（P＜0.05），而大于6小时组仍无明显改变（P＞0.05）；术后6个月时两亚组EDV、ESV、Tmsv-16-Dif%、Tmsv-16-SD%均小于术后1周内（P＜0.05），且两亚组间ESV、Tmsv-16-Dif%、Tmsv-16-SD%差别已不明显（P＞0.05）。 5、RT-3DE测量左室容积与射血分数与CMRI所测结果具有良好的一致性、相关性。结论： 1.RT-3DE可准确、详细、定量评估AMI患者左室收缩、舒张功能及左室收缩同步性。 2.AMI患者左室发生了不同程度的重构，RT-3DE能够定量分析PCI治疗术后这一变化，评价疗效及预后。 3.RT-3DE与CMRI测值有良好的一致性与相关性。
[Abstract]:Objective: to quantitatively analyze left ventricular systolic and diastolic function and left ventricular systolic synchrony after PCI in patients with acute myocardial infarction (AMI) by real-time three-dimensional echocardiography (RT-3DE) and evaluate the changes of left ventricular remodeling. Methods: 2DE and RT-3DE were performed in 63 patients with acute myocardial infarction (group A) and 38 healthy subjects (group B) after PCI. Left ventricular systolic function: left ventricular end-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular ejection fraction (LVEF),) were compared between two groups. Group B: segmental contraction function (rEDV,rESV,rEF), segmental maximum ejection rate and maximum filling rate (rPER,rPFR). And left ventricular systolic synchrony: left ventricular maximum difference from 16 segments to minimum end-systolic volume time, standard deviation and the percentage of cardiac cycle (Tmsvl6-Dif,Tmsvl6-Dif%,Tmsvl6-SD,Tmsvl6-SD%), The differences of parameters between the two groups were compared, and the correlation between EF and left ventricular systolic synchrony parameters in myocardial infarction group was analyzed. 3. The parameters of infarct related segments in myocardial infarction group within 1 week, 3 months after operation and 6 months after operation were compared with those of myocardial infarction group in 1 week, 3 months and 6 months after operation. In addition, 10 volunteers (group C) were examined with RT-3DE, cardiac magnetic resonance (CMRI) simultaneously (within 24 hours). The correlation and consistency of RT-3DE with EDV,ESV and EF measured by CMRI were evaluated by linear regression and Bland-Altman analysis. Results: 1 there was no significant difference in EDV,ESV,EF between group A and group A (P < 0. 05) by), B method (P > 0. 05). 2Infarction related segmental volume parameters (rEDV,rESV) and left ventricular systolic synchronism (Tmsv-16-Dif,Tmsv-16-Dif%,Tmsv-16-SD,Tmsv-16-SD%) in group A were higher than those in group B (P < 0. 05). The segmental systolic and diastolic function parameters (rPER,rPFR,rEF) were significantly lower in group B than in group B (P < 0. 05). There was a negative correlation between EF and synchronism of left ventricular systolic parameters in group B (P < 0. 05). 3 at 3 months after operation, the segmental volume and left ventricular systolic synchronism in group A were less than those in 1 week after operation, and the systolic and diastolic function parameters were larger than those in 1 week after operation (P < 0.05). There was no significant difference in the above parameters between 6 months after operation and 3 months after operation (P > 0.05). 4. The opening time of coronary artery was less than 6 hours than that of more than 6 hours. The EDV,ESV of the more than 6 hours group was smaller than that of the 6 hours group (P < 0. 05), and the Tmsv-16-Dif%, was significantly higher than that of the 6 hour group (P < 0. 05). There was no significant difference in Tmsv-16-SD% (P > 0. 05). The Tmsv-16-Dif%,Tmsv-16-SD% of the group less than 6 hours after operation decreased significantly (P < 0. 05), but the group of more than 6 hours had no significant change (P > 0. 05). At 6 months after operation, the EDV,ESV,Tmsv-16-Dif%,Tmsv-16-SD% of the two subgroups was lower than that of the first week after operation (P < 0. 05), and there was no significant difference in ESV,Tmsv-16-Dif%,Tmsv-16-SD% between the two subgroups (P > 0. 05). The results of left ventricular volume and ejection fraction measured by RT-3DE were in good agreement with those measured by CMRI. Conclusion: 1.RT-3DE can accurately and quantitatively evaluate left ventricular systolic and diastolic function and left ventricular systolic synchrony in AMI patients. Left ventricular remodeling occurred in different degree in patients with 2.AMI. RT-3DE can quantitatively analyze the changes after PCI treatment and evaluate the curative effect and prognosis. There is good consistency and correlation between 3.RT-3DE and CMRI.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

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