二维斑点追踪技术预测急性心肌梗死患者介入治疗后左心室功能改善程度

摘要

Objective To assess the left ventricular function of patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI) by speckle tracking imaging (STI).Methods 75 AMI patients who had AMI for the first time and have been treated by primary PCI were enrolled.Dynamic images were acquired before PCI,at 6 months after PCI and analyzed by STI.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS),radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI.According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI,patients were divided into left ventricular function improved group (△LVEF≥5％) and not-improved group.Results Compared to non-improved group,LPSS (P ＜0.001),RPSS (P ＜0.05,P ＜0.001) and CPSS (P ＜0.001) of improved group were all higher before and 6 months after PCI.LPSS (r =-0.578,P ＜0.001) and CPSS (r =-0.817,P ＜0.001) before PCI were both closely related to △LVEF.In single parameter mode of ROC curve analysis,the area under the ROC curve (AUC) (0.867),sensitivity (94.7％) and specificity (74.4％) of CPSS are relatively higher than other STI parameters.In multiple parameters united mode of ROC curve analysis,AUC (0.897),sensitivity (94.7％) and specificity (74.4％) of LPSS,RPSS and CPSS united were the highest among all the combinations of all STI parameters.Conclusions Left ventricular function improvement of patients with AMI 6 months after PCI is accurately assessed and predicted by STI.CPSS is a strong predictor for left ventricular function improvement 6 months after PCI of AMI patients among all the STI parameters and is an effective indicator for the assessment of left ventricular function improvement of AMI patients.%目的 应用二维斑点追踪显像(STI)技术评价急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)术后6个月时的心功能,探讨STI参数预测AMI患者心功能改善程度的临床价值.方法 首次发作AMI经PCI治疗的患者75例,采集PCI术前、术后6个月左心室图像,分析左心室峰值纵向应变(LPSS)、峰值径向应变(RPSS)及峰值环向应变(CPSS),以术后6个月左心室射血分数(LVEF)与术前相比,以LVEF改善幅度(△LVEF)＞5％为标准分为心功能改善组和非改善组.结果 改善组在PCI术前及术后6个月时LPSS(P ＜0.001)、RPSS(P＜0.05,P＜0.001)及CPSS(P＜0.001)均明显高于非改善组.PCI术前LPSS(r=-0.578,P＜0.001)及CPSS(r=-0.817,P＜0.001)均与△LVEF有显著相关性.ROC曲线单参数分析中CPSS的曲线下面积较大(0.867),灵敏度(81.4％)及特异度(84.2％)较高,截值为-10.81％;在多参数联合分析中,LPSS、RPSS及CPSS联合曲线下面积较大(0.897),灵敏度(94.7％)及特异度(74.4％)较高.结论 STI技术能准确预测PCI术后AMI患者心功能的改善,其环向运动指标CPSS具有较强的诊断优势,是评价AMI患者左心室功能恢复的有效指标.