二维斑点追踪成像对急性心肌梗死患者经皮冠状动脉介入效果的评价及其与高敏肌钙蛋白 T的相关性

摘要

目的：采用二维斑点追踪成像（2D-STI）评价急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）治疗的效果，探讨梗死节段纵向应变（LS）峰值与高敏肌钙蛋白T （hs-cTnT）的相关性。方法选取2012年12月—2013年12月于佳木斯大学附属第一医院接受 PCI术的AMI患者40例为研究对象，按照心肌梗死部位分为急性前壁心肌梗死组（21例）和急性下壁心肌梗死组（19例）。分别于PCI术前及术后4周采用2D-STI技术测定心肌病变节段LS峰值，并测定hs-cTnT水平。结果 AMI患者PCI术前各病变节段运动幅度减低， LS-时间曲线形态杂乱；术后4周，各病变节段运动幅度略恢复， LS-时间曲线形态较规整。急性前壁心肌梗死组术前与术后4周前壁基底段、中间段和心尖段LS峰值比较，差异均有统计学意义（ P＜0.001）。急性下壁心肌梗死组术前与术后4周基底段、中间段和心尖段LS峰值比较，差异均有统计学意义（ P＜0.05）。急性前壁心肌梗死组术前hs-cTnT水平为404.2（344.0）μg／L，术后4周hs-cTnT水平为1.2（9.0）μg／L，差异有统计学意义（z＝-4.015， P＜0.001）。急性前壁心肌梗死组基底段、中间段和心尖段LS峰值变化与hs-cTnT水平变化均呈正相关（rs ＝0.74、0.75、0.74， P＜0.001）。急性下壁心肌梗死组术前hs-cTnT水平为308.4（641.0）μg／L，术后4周hs-cTnT水平为1.9（2.6）μg／L，差异有统计学意义（ z＝-3.823， P＜0.001）。急性下壁心肌梗死组基底段、中间段和心尖段LS峰值变化与hs-cTnT水平变化均呈正相关（rs＝0.65、0.75、0.78， P＜0.05）。结论 AMI患者PCI术后各节段LS峰值高于术前，且LS峰值变化与hs-cTnT水平变化有良好的相关性。2 D-STI可定量评价AMI患者PCI术前后心肌的运动功能，可作为评价PCI术疗效的良好方法。%Objective To evaluate the efficacy of PCI on patients with AMI by 2D -STI and to investigate the correlation between the peak value of longitudinal stain ( LS) of the infarction segment and hs-cTnT.Methods We enrolled 40 AMI patients who received PCI in the First Affiliated Hospital of Jiamusi University from December 2012 to December 2013.The subjects were divided into acute anterior wall myocardial infarction group ( n=21 ) and acute inferior wall myocardial infarction group (n=19).Before PCI and 4 weeks after PCI, the LS peak value of each myocardial segment was determined using 2D-STI, and hs-cTnT level was also examined .Results Before PCI, the motor extent of each lesion segment of the subjects decreased , and the LS-time curves were in disorder; four weeks after PCI , the extent of ventricular wall motion of each lesion segment recovered slightly , and the LS-time curve was in order .Four weeks after PCI , the LS peak values of the wall basal segment, middle segment and apical segment of acute anterior wall myocardial infarction group were significantly different ( P<0.001) from those before PCI.Four weeks after PCI, the LS peak values of the inferior wall basal segment , middle segment and apical segment of acute inferior wall myocardial infarction group were significantly different ( P<0.05 ) from those before PCI . The level of hs-cTnT of acute anterior wall myocardial infarction group was 404.2 ( 344.0 ) μg/L before PCI and was 1.2 (9.0) μg/L four weeks after PCI, with significantly different between them (z=-4.015, P<0.001).The change of LS peak values of the anterior wall basal segment , middle segment and apical segment of acute anterior wall myocardial infarction group were positively correlated with the change of hs-cTnT level (rs =0.74, 0.75, 0.74; P<0.001).The level of hs-cTnT of acute inferior wall myocardial infarction group was 308.4 ( 641.0 ) μg/L before PCI and was 1.9 ( 2.6 ) μg/L four weeks after PCI, with significant difference between them (z=-3.823, P<0.001).The change of LS peak values of the inferior wall basal segment , middle segment and apical segment of acute anterior wall myocardial infarction group were positively correlated with the change of hs-cTnT level (rs=0.65, 0.75, 0.78; P<0.05).Conclusion AMI patients have higher LS peak value of each segment than that before PCI , and the change of LS peak value has positive correlation with the change of hs-cTnT level.Through 2D-STI, quantitative evaluation could be conducted on the myocardial motor function in AMI patients before and after PCI.2D-STI is a good method for the efficacy evaluation of PCI .