实时三维超声心动图评价冠心病患者左前降支冠状动脉PCI术后左心室整体及局部收缩功能与同步性

摘要

To assess the clinical value of real-time three-dimensional echocardiography (RT-3DE) in evaluating the whole and regional left ventricular systolic function and synchrony in coronary artery disease patients after percutaneous transluminal coronary intervention (PCI) of left anterior descending (LAD), Methods RT-3DE was performed on 30 patients before PCI of LAD and 1 week, 1 and 3 months after PCI. The 17-segmental time-volumetric curves were analyzed, and the global systolic function parameters (EDV, ESV,EF) and synchronic parameters (Tmsv 16-SD%) were obtained. Tmsv 16-SD% was served as the systolic dyssynchrony index (SDI). Regional systolic function parameters (rEDV, rESV, rEF) and synchronic parameters (Tmsv%) were also obtained. Results Compared with before and 1 week after PCI, the global EDV, ESV, rESV and rEDV of most segments decreased 1 month later (P<0. 05), while the EF and rEF increased (P<0. 05). Tmsv-16-SD% and Tmsv% of some segments decreased compared with those preoperation (P< 0. 05), while no statistical difference was found with 1 week after PCI (P>0. 05). Three months after PCI, the global ESV> Tmsv-16-SD% and rEDV, rESV, Tmsv% of most segments group decreased (P<0. 05), while the EF and rEF of most segments increased (P<0. 05), the global rEDV decreased compared with preoperation and 1 week after PCI (P< 0. 05), while no statistical difference was found with 1 month after PCI (P>0. 05). Conclusion RT-3DE is a useful method in assessing the whole and regional left ventricular systolic function and synchrony in coronary artery disease patients after PCI of LAD.%目的 探讨实时三维超声心动图(RT-3DE)评价冠心病左前降支冠状动脉经皮介入治疗(PCI)后患者左心室整体及局部收缩功能与同步性的应用价值.方法 对30例接受左前降支PCI术的患者分别于术前、术后1周,1、3个月应用RT-3DE进行17节段时间-容积曲线分析,获得左心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及左心室16节段达到最小收缩容积时间差的标准差校正值(Tmsv-16-SD％),即收缩不同步指数(SDI)；同时得到前壁、前间隔及心尖帽共7节段的舒张末期容积(rEDV)、收缩末期容积(rESV)、节段射血分数(rEF)及节段达到最小收缩容积时间的校正值(Tmsv％).结果 术后1个月EDV、ESV、rESV及大部分节段的rEDV低于术前及术后1周(P＜0.05),EF、rEF高于术前及术后1周(P＜0.05),Tmsv-16-SD％及局部节段Tmsv％低于术前(P＜0.05),与术后1周无明显差异(P＞0.05)；术后3个月ESV、Tmsv- 16-SD％及大部分节段的rEDV、rESV、Tmsv％低于术前、术后1周及术后1个月(P＜0.05),EF及大部分节段的rEF高于术前、术后1周及术后1个月(P＜0.05),rEDV低于术前及术后1周,与术后1个月相比较无明显差异(P＞0.0 5).结论 利用RT-3DE能定量评价冠心病患者左前降支PCI术后左心室整体及局部收缩功能与同步性的改善情况.