CAJ | 학술논문

目的探讨实时三维超声心动图(RT-3DE)左心室同步性指标预测冠心病(CAD)患者冠状动脉旁路移植术(CABG)后左心室逆重构价值.方法经选择性冠状动脉造影证实为3支冠状动脉病变的31例CAD患者,应用RT-3DE于术前及术后1个月测量左心室舒张末容积(LVEDV)及16节段同步性等指标,依据CABG术后LVEDV减少≥15%为左心室逆重构标准将病例组分为有反应组(A组,LVEDV减少≥15%)和无反应组(B组,LVEDV减少＜15%),并与20例冠状动脉正常的受检者对比分析,且对CAD患者LVEDV与左心室16节段达峰时间最大差值(Tmsv16-Dif)及标准差(Tmsv16-SD)做相关分析.结果与对照组比较,CAD患者手术前后左心室同步性指标均显著降低(P<0.01);与术前比较,A组左心室同步性有显著提高(P<0.01),B组则无明显提高改善(P>0.05).CAD患者LVEDV与左心室Tmsv16-Dif及Tmsv16-SD均呈显著正相关(分别为r=0.751,P<0.01;r=0.655,P<0.01).结论 CABG术后发生左心室逆重构的患者其同步性提高,且LVEDV与左心室同步性指标相关良好,此表明左心室同步性指标亦可作为一种新的预测心室逆重构的方法应用于临床.
목적 탐토실시삼유초성심동도(RT-3DE)좌심실동보성지표예측관심병(CAD)환자관상동맥방로이식술(CABG)후좌심실역중구개치.방법 경선택성관상동맥조영증실위3지관상동맥병변적31례CAD환자,응용RT-3DE우술전급술후1개월측량좌심실서장말용적(LVEDV)급16절단동보성등지표,의거CABG술후LVEDV감소≥15%위좌심실역중구표준장병례조분위유반응조(A조,LVEDV감소≥15%)화무반응조(B조,LVEDV감소＜15%),병여20례관상동맥정상적수검자대비분석,차대CAD환자LVEDV여좌심실16절단체봉시간최대차치(Tmsv16-Dif)급표준차(Tmsv16-SD)주상관분석.결과 여대조조비교,CAD환자수술전후좌심실동보성지표균현저강저(P<0.01);여술전비교,A조좌심실동보성유현저제고(P<0.01),B조칙무명현제고개선(P>0.05).CAD환자LVEDV여좌심실Tmsv16-Dif급Tmsv16-SD균정현저정상관(분별위r=0.751,P<0.01;r=0.655,P<0.01).결론 CABG술후발생좌심실역중구적환자기동보성제고,차LVEDV여좌심실동보성지표상관량호,차표명좌심실동보성지표역가작위일충신적예측심실역중구적방법응용우림상.
Objective To investigate the value of predicting left ventricular reverse remodeling in patients after coronary artery bypass graft by using the left ventricular synchronized indices derived from real-time three-dimensional echocardiography.Methods Left ventricular end-diastolic volume (LVEDV) and 16-segments synchronized indices were measured by Real-time three-dimensional echocardiography (RT3DE) in 31 patients with three-vessels of coronary artery disease (CAD) before and 1 month after coronary artery bypass grafting (CABG) and control group .The patients group was divided into responding group (group A,reduction of LVEDV≥15% 1 month after CABG) and non-responding group (group B,reduction of LVEDV＜15% 1 month after CABG).All the data were compared between patients group and control group.The correlation of LVEDV and Tmsv16-SD as well as Tmsv16-Dif was analysed statistically.Results Compared with control group,the left ventricular synchronized indices significantly decreased in patients group including pre and post-operation cases (P<0.01).Compared with pre-operative period,the left ventricular synchronized indices were significantly increased in group A (P<0.01).On the contrary,there was no significant change in group B (P>0.05).In CAD group,there were obvious positive correlations between LVEDV and Tmsv16-SD as well as Tmsv16-Dif (r=0.751,P<0.01;r=0.655,P<0.01).Conclusions The synchronization had significant improvement in patients with reverse remodeling of left ventricle after CABG,and there were positive correlations between LVEDV and Tmsv16-SD as well as Tmsv16-Dif.Hence Tmsv16-SD and Tmsv16-Dif could be a new kind of indices to predict left ventricular reverse remodeling.