斑点追踪成像评价射血分数保留的急性前壁心肌梗死后左室重构

发布时间：2018-04-13 23:37

  本文选题：斑点追踪成像 + 应变　； 参考：《暨南大学》2017年硕士论文

【摘要】：目的探讨二维斑点追踪成像(STI)技术是否可以评价射血分数保留的急性前壁心肌梗死后左心室重构。方法50例射血分数保留的急性前壁心肌梗死患者,入院后立即行超声心动图检查,并于经皮冠状动脉介入治疗(PCI)术后6个月后根据有无左室重构分为两组,检测两组心尖各切面(两腔心、三腔心、四腔心切面)左室心肌纵向峰值收缩应变(LS)、纵向峰值收缩应变率(LSR)、纵向峰值收缩总应变(GLS)、纵向峰值收缩总应变率(GLSR)、受损纵向应变(Inj LS)、受损纵向应变率(Inj LSR);检测两组左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左室射血分数(LVEF)、室壁运动积分指数(WMSI)、舒张早期二尖瓣血流速度/舒张早期二尖瓣环运动速度(E/e’);分析左室重构组的LVESV、LVEDV、LVEF、WMSI、E/e’等超声心动图参数与纵向峰值收缩总应变(LS)、纵向峰值收缩总应变率(LSR)、受损纵向应变(Inj LS)、受损纵向应变率(Inj LSR)的相关性,并对纵向峰值收缩总应变(LS)、纵向峰值收缩总应变率(LSR)、受损纵向应变(Inj LS)、受损纵向应变率(Inj LSR)的进行ROC曲线分析。结果左室重构组与非左室重构组的左室收缩末期容积增加量百分比(△LVESV%)、左室舒张末期容积增加量百分比(△LVEDV%)、WMSI、E/e’值的差别有统计学意义,P0.05;左室重构组的纵向峰值收缩总应变与LVEF(r=0.96,P0.01)呈正相关,纵向峰值收缩总应变率与LVEF(r=0.97,P0.01)呈正相关,受损纵向应变与LVEF(r=0.81,P0.01)呈正相关,受损纵向应变率亦与LVEF(r=0.95,P0.01)呈正相关。纵向峰值收缩总应变≥-14%时,诊断射血分数保留的急性前壁心肌梗死后左室重构的敏感度为88.2%,特异度为87.9%;纵向峰值收缩总应变率≥-1.1 S-1时,诊断射血分数保留的急性前壁心肌梗死后左室重构的敏感度为94.1%,特异度为42.4%;受损纵向应变≥-11%时,诊断射血分数保留的急性前壁心肌梗死后左室重构的敏感度为88.2%,特异度为63.6%;受损纵向应变率≥-1.0 S-1时,诊断射血分数保留的急性前壁心肌梗死后左室重构的敏感度为88.2%,特异度为69.7%。结论(1)斑点追踪成像技术可以初步评价射血分数保留的急性前壁心肌梗死患者的左室形变、心肌局部和整体功能。(2)斑点追踪成像技术可以成为定量评价射血分数保留的急性前壁心肌梗死后左室重构及临床预后提供重要预测信息。(3)结合纵向峰值收缩总应变及受损纵向应变、受损纵向应变率可以更好地预测射血分数保留的急性前壁心肌梗死后左室重构。
[Abstract]:Objective to investigate whether two-dimensional speckle tracking imaging (STI) can evaluate left ventricular remodeling after acute anterior myocardial infarction (AMI) with retained ejection fraction (EF).Methods Fifty patients with acute anterior wall myocardial infarction with retained ejection fraction were examined by echocardiography immediately after admission and divided into two groups according to left ventricular remodeling 6 months after percutaneous coronary intervention (PCI).Two groups of apical sections (two cavities, three cavities) were detected.Four-chamber section) left ventricular myocardial longitudinal peak systolic strain (LSN), longitudinal peak systolic strain rate (LSRR), longitudinal peak systolic total strain (GLSN), longitudinal peak systolic total strain rate (GLSRN), damaged longitudinal strain (Inj LSN), damaged longitudinal strain rate (LSR) and Inj LSRG;The left ventricular end-diastolic volume (LVEDVV), end-systolic volume (LVESVV), left ventricular ejection fraction (LVEF), wall motion integral index (WMSI), early diastolic mitral flow velocity / early diastolic mitral annular velocity (E / E) in the left ventricular remodeling group were analyzed.The correlation between the parameters of isoechocardiography and the total strain of the longitudinal peak contraction, the total strain rate of the longitudinal peak contraction, the damaged longitudinal strain, the damaged longitudinal strain rate and the damage of the longitudinal strain rate (Inj LSRs).The ROC curves were analyzed for the total strain of longitudinal peak contraction, the total strain rate of longitudinal peak contraction, the damaged longitudinal strain, the damaged longitudinal strain and the damaged longitudinal strain rate.Results there was significant difference between left ventricular remodeling group and non-left ventricular remodeling group in left ventricular end-systolic volume (LVESVV) and left ventricular end-diastolic volume increment (LVEDVV) (P < 0.05), and the longitudinal peak of left ventricular remodeling group (LVEVV) was significantly higher than that of non-left ventricular remodeling group (P < 0.05), and there was a significant difference between left ventricular remodeling group and non-left ventricular remodeling group (P < 0.05).There was a positive correlation between the total strain of value contraction and that of LVEF ru 0.96g P 0.01).There was a positive correlation between the total strain rate of longitudinal peak contraction and that of LVEFN 0.97 (P0.01), a positive correlation between the damaged longitudinal strain and LVEF0.81 (P0.01), and a positive correlation between the damaged longitudinal strain rate and LVEF0.95 (P0.01).When the total longitudinal peak systolic strain 鈮，

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