急诊经皮冠状动脉介入术后心肌灌注对心肌收缩功能恢复的预测价值

摘要

目的 探讨急诊经皮冠状动脉介入术(PPCI)后心肌微循环灌注水平对心肌收缩功能恢复程度的预测价值,以早期发现心肌无复流,改善患者不良预后.资料与方法 选取49例接受PPCI治疗的急性心肌梗死(AMI)患者为研究对象,术后1周内行二维应变成像(2DS)、静息定性心肌声学造影(MCE)检查,术后3个月复查2DS.应用2DS测量各节段心肌收缩期纵向峰值应变(LPSS),并根据LPSS牛眼图彩色编码将左心室心肌分为收缩功能正常(红色)、收缩功能受损(浅红色、蓝色)心肌.应用MCE目测半定量法对各节段心肌进行灌注评分(MPS),并根据MPS将收缩功能受损心肌分为灌注良好、灌注减少、灌注缺失心肌.比较各灌注水平间△LPSS(3个月各节段心肌LPSS与术后1周的差值),同时将MPS分别与术后1周、术后3个月LPSS行相关性分析.结果 △LPSS的组间比较为灌注良好心肌＞灌注减少心肌＞灌注缺失心肌[(-5.78±6.23)％比(-4.37±6.60)％比(-1.21±4.77)％,P＜0.05];PPCI术后1周心肌MPS与术后1周、术后3个月LPSS均呈正相关(r=0.47、0.58,P＜0.001);2名评估者对心肌灌注评分一致性较好(Kappa=0.785,P＜0.05).结论 AMI患者PPCI术后心肌灌注水平与心肌收缩功能相关,可预测心肌收缩功能恢复程度.%Purpose To explore the predictive value of myocardial perfusion in assessing myocardial systolic function recovery after primary percutaneous coronary intervention (PPCI),in order to improve poor prognosis by early detection of myocardial no-reflow.Materials and Methods Forty nine patients with acute myocardial infarction (AMI) who had received PPCI were chosen as subjects.All the patients underwent two-dimensional strain (2DS) images and resting real-time myocardial contrast echocardiography (MCE) within one week after surgery,and 2DS measurement was repeated after three months.2DS imaging was used to acquire longitudinal peak systolic strain (LPSS) at all myocardial segments.Based on the graphs of LPSS,left ventricular myocardium was divided into normal contractile function myocardium (red) and impaired contractile function myocardium (light red,blue).According to the myocardial perfusion scores (MPS) qualitatively assessed by MCE visual interpretation,the myocardia with impaired systolic function were categorized into three groups with different perfusion level.The changes of LPSS within one week and three months after surgery (△ LPSS) among the three groups were analyzed.The correlation between MPS and LPSS within one week and three months after PPCI was also analyzed respectively.Results The △ LPSS increased significantly among the three groups with the improvement of myocardial perfusion level [(-5.78±6.23)％ vs.(-4.37±6.60)％ vs.(-1.21 ±4.77)％,all P＜0.05].The MPS measured one week after PPCI was both positively correlated with the LPSS detected within one week after surgery and that after three months (r=0.47,0.58,P＜0.001).The consistence of myocardial perfusion scores given by two evaluators was good (Kappa=0.785,P＜0.05).Conclusion The level of myocardial perfusion after PPCI in patients with AMI is closely related to regional myocardial systolic function,and the improvement of myocardial perfusion can forecast the recovery of regional systolic function.