二维斑点追踪纵向应变评价急性左心室下壁合并右心室心肌梗死患者右心室收缩功能

摘要

目的 探讨二维斑点追踪(2D-STI)技术右心室纵向应变(RVLS)参数用于评价急性左心室下壁心肌梗死(INFMI)合并右心室心肌梗死(RVMI)患者右心室收缩功能的临床价值.方法 RVMI组为急性INFMI合并RVMI患者17例,INFMI组为不合并RVMI的INFMI患者21例.RVMI组与INFMI组统称急性心肌梗死(AMI)组.对照组为24例因胸痛同期连续入院而冠脉造影未见明显狭窄的患者.入院后48 h内进行超声心动图检查,在心尖四腔观应用2D-STI应变分析软件获取右心室纵向应变(LS)、纵向应变率(LSr)曲线.结果 AMI组患者右心室整体纵向应变(RVGLS)、游离壁及间隔壁基底及中间段LS绝对值以及游离壁基底及中间段LSr绝对值较对照组减低(P均＜0.05),且RVMI组较INFMI组患者RVGLS、游离壁中间段及心尖段LS绝对值以及间隔中间段LSr绝对值降低(P均＜0.05).ROC曲线分析结果表明,右心室游离壁均值纵向应变(RVFWLS)及RVGLS对RVMI有更高的诊断效率,RVFWSL的诊断截值为-18.26％(灵敏性1oo％,特异性65.5％),RVGLS的诊断截值为-16.27％(灵敏性100％,特异性72.4％).结论 2D-STI RVLS参数能够准确反映急性INFMI或INFMI合并RVMI患者右心室收缩功能受损,合并RVMI患者右心室收缩功能损害更重,整体收缩功能降低,以游离壁为主.RVLS参数对急性INFMI合并RVMI诊断效率高,可为急性RVMI的临床诊断及早期右心室功能评定提供更多参考依据.%Objective To assess right ventricular (RV) systolic function in patients with acute right ventricular myocardial infarction (RVMI) in association with left ventricular inferior myocardial infarction (INFMI) by applying 2-dimensional (2D) speckle tracking imaging (STI) longitudinal strain (LS) and strain rate (LSr) parameters.Methods Seventeen consecutive patients diagnosed with INFMI in association with RVMI were included in our study,21 INFMI patients without RVMI were also included to match the RVMI group.RVMI group and INFMI group were called acute myocardial infarction (AMI) group,all of them were diagnosed AMI the first time.Twenty-four chest pain patients admitted consecutively at the same time but with negative results in the selective coronary angiography were served as blank control.Echocardiography were performed within 48 hours.The RVLS parameters,which include LS and LSr,were then analyzed offline.Results The RV global LS (RVGLS),the LS of the basal and mid segments of the free wall and septum,the LSr of the basal and mid segments of the free wall were lower than control group in the AMI group (P ＜0.05).Compared to INFMI group,the RVGLS,the LS of the mid and apical segments of the free wall and the LSr of the mid segments of the septum were lower in the RVMI group (P ＜ 0.05).In the single parameter mode of ROC curve analysis,the diagnosis efficiency of RV free wall LS (RVFWLS) and RVGLS were higher than other parameters.The cut-off value of RVFWLS and RVGLS were-18.26％ and-16.27％ respectively (sensitivity were 100％ and 100％,respectively,specificity were 65.5％ and 72.4％,respectively).Conclusions The 2D-STI RVLS parameters precisely reflect the impaired RV systolic function in the INFMI and RVMI patients,the RV global systolic function are even worse when RVMI involved,mainly for the RV free wall.RVLS parameters are good predictors of RVMI which could provide more references for the early diagnosis and functional evaluation of RV in acute INFMI patients with RVMI.