CAJ | 학술논문

目的应用二维斑点追踪技术(STI)评价经皮冠状动脉介入术(PCI)治疗后急性心肌梗死(AMl)患者左心室功能变化,探讨STI评价AMI患者随访时心功能变化特点.方法采集73例经PCI治疗首发AMI患者术前、术后3个月及6个月左室图像,分析峰值纵向应变(LPSS)、峰值径向应变(RPSS)及峰值环向应变(CPSS),以术后6个月左室射血分数(LVEF)与术前相比(ΔLVEF6)改善幅度＞5％分为心功能改善组和非改善组；术后3个月LVEF与术前相比(ΔLVEF3)改善幅度＞5％将改善组分为近期和中远期改善组.结果改善组术前、术后STI各项参数均高于非改善组(P＜0.001).近期改善组术前、术后LPSS及术后3个月RPSS均高于中远期改善组(3个月时LPSSP＜0.001,余参数P＜0.05).STI各项参数均与ΔLVEF3和ΔLVEF6存在相关性,其中术前LPSS与ΔLVEF3相关性较大(r=-0.781,P＜0.001),术后6个月CPSS与ΔLVEF6相关性较大(r=-0.834,P＜0.001).结论 STI技术能准确评价AMI患者近期及中远期室壁运动变化；心肌梗死后左室纵向运动功能的保留对心功能近期改善较为重要,环向运动功能的保留和恢复是中远期仍能持续改善的关键.
목적 응용이유반점추종기술(STI)평개경피관상동맥개입술(PCI)치료후급성심기경사(AMl)환자좌심실공능변화,탐토STI평개AMI환자수방시심공능변화특점.방법 채집73례경PCI치료수발AMI환자술전、술후3개월급6개월좌실도상,분석봉치종향응변(LPSS)、봉치경향응변(RPSS)급봉치배향응변(CPSS),이술후6개월좌실사혈분수(LVEF)여술전상비(ΔLVEF6)개선폭도＞5％분위심공능개선조화비개선조；술후3개월LVEF여술전상비(ΔLVEF3)개선폭도＞5％장개선조분위근기화중원기개선조.결과 개선조술전、술후STI각항삼수균고우비개선조(P＜0.001).근기개선조술전、술후LPSS급술후3개월RPSS균고우중원기개선조(3개월시LPSSP＜0.001,여삼수P＜0.05).STI각항삼수균여ΔLVEF3화ΔLVEF6존재상관성,기중술전LPSS여ΔLVEF3상관성교대(r=-0.781,P＜0.001),술후6개월CPSS여ΔLVEF6상관성교대(r=-0.834,P＜0.001).결론 STI기술능준학평개AMI환자근기급중원기실벽운동변화；심기경사후좌실종향운동공능적보류대심공능근기개선교위중요,배향운동공능적보류화회복시중원기잉능지속개선적관건.
Objective To assess left ventricular function early and late improvement of patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI) by speckle tracking imaging (STI).The clinical values of the assessment of STI for the prognosis and heart function improvement of AMI patients treated by PCI were discussed.Methods 73 AMI patients who had AMI for the first time and had been treated by primary PCI from September 2010 to July 2011 and were examined in the follow-ups from December 2010 to February 2012 in our hospital were enrolled.Dynamic images were acquired before PCI,at 3 months and 6 months after PCI and analyzed by STI.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS),radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI.According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI,patients were divided into left ventricular function improved group (ΔLVEF6＞5％) and not-improved group.According to the comparison of LVEF before PCI and 3 months after PCI,improved group were divided into left ventricular function early-improved group (ΔLVEF3 ＞5％) and late-improved group.Results The values of all STI parameters before PCI,3 months and 6 months after PCI in improved group were higher than those in not-improved group (P ＜0.001,all).LPSS before PCI and at the follow-ups and RPSS at 3 months after PCI in early-improved group were higher than those in late-improved group (LPSS at 3 months after PCI:P＜0.001;Other parameters:P ＜0.05).There were significant correlations between all STI parameters and both ΔLVEF3 and ΔLVEF6.LPSS before PCI was more closely related to ΔLVEF3 (r =-0.781,P ＜0.001).CPSS at 6 months after PCI was more closely related to ΔLVEF6 (r =-0.834,P ＜ 0.001).Conclusions Early and late function improvement of left ventricle in AMI patients who is treated by PCI are accurately assessed by STI.The precise analyses of longitudinal and circumferential movements in STI are important for clinical diagnosis.