室壁分层分析技术评价ST段抬高心肌梗死患者的心肌运动

Layer-specific Analysis in Patients with ST Segment Elevation Myocardial Infarction

中文关键词:  室壁分层分析 心肌梗死 左室重塑

英文关键词:Layer-specific analysis Myocardial infarction Left ventricular remodeling

中文摘要:

      目的 运用室壁分层分析技术评价ST段抬高心肌梗死（STEMI）患者左室壁三层心肌运动情况及其预测左室重塑的能力。方法 纳入成功行直接冠脉介入（P-PCI）的初次STEMI患者39例及30例正常对照。在P-PCI术后48 h内(随访前)及6个月时(随访时)行超声心动图检查。分析三维心功能及室壁长轴及圆周内、中、外三层应变。结果 ① STEMI患者随访前室壁长轴内层应变高于外层（P <0.01)，圆周分层应变由内向外减小（P <0.01)。左室壁长轴及圆周三层应变随访时均较随访前增高（P <0.01)，但仍低于正常对照组（P <0.05)。②左室重塑组随访前、随访时左室壁分层应变低于非重塑组（P <0.05），两组随访时分层应变均较随访前增高（P <0.05）。③长轴外层应变是左室重塑的独立预测因素（比值比:3.332，95%可信区间：1.124～3.882，P =0.03），其预测左室重塑切点值为-9%（敏感度89.5%，特异度70.2%）。结论 P-PCI术后48 h内STEMI患者室壁应变从内层向外层减低，左室重塑组心肌功能低于非重塑组，左室壁长轴外层应变可独立预测STEMI患者的左室重塑。

英文摘要:

      Objective To evaluate left ventricular wall function after ST segment elevation myocardial infarction(STEMI) by layer-specific analysis and determine if the layer-specific parameters can predict left ventricular remodeling(LVR). Methods Thirty nine patients with first STEMI who had successful primary percutaneous coronary intervention(P-PCI) were studied, while 30 healthy individuals were included as normal control. Echocardiographic examinations were performed in STEMI patients within 48 h after P-PCI (before follow-up) and 6 months later (follow-up). Three dimensional cardiac function and longitudinal, circumferential 3-layer strain were analyzed. Results In STEMI, longitudinal endocardial strain was higher than epicardial strain (P<0.01), circumferential strain decreased from endocardium to epicardium gradually (P<0.01). Longitudinal and circumferential 3-layer strain at follow-up was higher than that before follow-up (P<0.01), but lower than that in control group(P<0.05). LVR group had lower longitudinal and circumferential 3-layer strain （P<0.05). Longitudinal epicardial strain was the independent predictor of LVR(odds ratio:3.332,95% confidence interval：1.124-3.882,P=0.03), the cut off value of -9% yielded 89.5% sensitivity and 70.2% specificity. Conclusion Strain decreased from endocardium to epicardium within 48 h after P-PCI in STEMI. Myocardial function was lower in LVR group. Longitudinal epicardial strain could be employed as an independent predictor of LVR after STEMI.