实时三维超声心动图评价冠心病患者PCI术前后左室功能及收缩同步性的研究

摘要

Objective To evaluate the influence left ventricular function and systolic synchrony assessed by realtime three-dimensional echocardiography( RT-3DE ) before and after percutaneous coronary intervention therapy ( PCI ) in coronary heart disease patients. Methods By using RT-3DE, the three-dimensional parameters were repeatedly measured in thirty-eight patients with PCI treatment as CHD group before operation, 1st week and 3rd month after operation. Twenty-eight nomal subjects were enrolled as control group. The left ventricular end-diastolic volume( LVEDV ), left ventricular end-systolic volume( LVESV ), left ventricular ejection fraction( LVEF ), left ventricular stroke volume ( LVSV ), left ventricular peak ejection rate( PER ), left ventricular peak filling rate ( PFR), the time of minimal systolic volume of 16-segmental standard deviation( Tmsvl6-SD% ) and maximum difference ( Tmsvl6-Dif% ) were analyzed with software. Results Compared with the control group, LVEDV, LVESV,Tmsvl6-SD% ,Tmsvl6-Dif% were significantly higher ( P <0. 01 ), while LVEF, PER/EDV, PFR/EDV were lower ( P < 0. 01 ) in study group befroe operation. Compared with the preoperative group, LVEDV, LVESV, Tmsvl6-SD% , Tmsvl6-Dif% reduced significantly ( P < 0. 05,P < 0. 01 ), while LVEF, PER/EDV, PFR/EDV increased ( P <0. 05 ,P < 0. 01 ) in postoperative group. The bull-eye diagram showed that systolic timing delayed and systolic excursion attenuated in segments reduced significantly with CHD group after the operation. Conclusion Left ventricular remodeling could be found in patients with coronary heart dease and PCI might reverse the left ventricular remodeling somewhat. RT-3DE could be a new corrected valuable method of evaluating left ventricular function and systolic synchrony in patients with CHD before and after PCI.%目的 应用实时三维超声心动图(RT-3DE)评价冠心病患者经皮冠状动脉介入(PCI)治疗术前后左室功能及收缩同步性的影响.方法 行PCI术患者38例(冠心病组)于术前、术后1周、术后3个月及28例健康者(对照组)分别行常规二维及RT-3DE检查,通过脱机软件分析得出左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室射血分数(LVEF)、峰值射血率(PER)、峰值充盈率(PFR)、左室16节段达到最小收缩容积时间的标准差值和最大差值被标准化为心动周期的百分比(Tmsvl6-SD%、Tmsvl6-Dif%).结果 与对照组相比,冠心病组术前LVEDV、LVESV、Tmsvl6-SD%、Tmsvl6-Dif%显著增加(P<0.01),LVEF、PER/EDV、PFR/EDV显著减小(P<0.01);与术前比较,患者术后LVEDV、LVESV、Tmsvl6-SD%、Tmsvl6-Dif%显著减小(P<0.05,P<0.01),LVEF、PER/EDV、PFR/EDV显著增加(P<0.05,P<0.01).牛眼图可直观的显示冠心病组术后收缩延迟和活动减弱节段明显减少.结论 冠心病患者可发生左心室重构,PCI治疗能够逆转其重构.RT-3DE能够准确评价冠心病患者PCI术前后左室功能及收缩同步性.