超声三维斑点追踪技术定量评价不同部位心肌梗死患者心功能的研究

摘要

目的 应用超声三维斑点追踪技术定量评价不同部位心肌梗死(myocardial infarction,MI)患者左室心肌应变特征及与左室整体收缩功能的相关性.方法 使用三维斑点追踪技术对24例心梗患者及20例正常人进行心肌运动分析,自动计算左室射血分数(left ventricular ejection fraction,LVEF)和左室整体及各节段纵向、圆周、径向与面积收缩期峰值应变.结果 与正常对照组对比,前壁心肌梗死组左室12/17节段的面积峰值应变减低；集中于前、侧壁、室间隔及心尖部；下壁心肌梗死组左室11/17节段面积峰值应变减低,集中于下、后壁.与非梗死节段比较,梗死节段的纵向、圆周、径向及面积峰值应变均显著降低(P＜0.01).前壁心肌梗死组整体纵向、圆周、径向及面积峰值应变均与LVEF显著相关(r=-0.752,r=-0.892,r=0.828,r=-0.876,P＜0.01),下壁心肌梗死组各整体峰值应变与LVEF无显著相关(r=-0.08,r=0.113,r=0.044,r=-0.019,P＞0.05).结论 超声三维斑点追踪技术是准确、定量评价心脏局部室壁运动异常及整体收缩功能新的无创方法.面积应变峰值可能是全面、准确、定量评价心功能的新指标.%Objective This study was performed to evaluate the value and characteristics of left ventricular systolic strain and its relation to the left ventricular global systolic function in patients with myocardial infarction(MI) which were in different location by using 3D speckle tracking echocardiography (3D-STI).Methods In 24 patient with MI and 20 control subjects,the myocardial motion was recorded and analyzed with 3D-STI.Left ventricular cjection fraction (LVEF),longitudinal strain(LS),circumferential strain(CS),radial strain(RS) and area strain(AS) in regional myocardial segments were measured automatically.Results Compared with control subjects,AS reduced in 12/17 myocardial segments of the anterior wall MI group,and its reduced segments were mainly in anterior,lateral,septal and apical segments.And AS reduced in 11/17 myocardial segments of the inferior wall MI group,and its reduced segments were mainly in inferior,posterior segments.Compared with control segments,The LS,CS,RS and AS of infarction segments were reduced significantly (P＜0.01).In the anterior wall MI group,the global LS,CS,RS and AS were significantly correlated with LVEF(r=-0.752,r=-0.892,r=0.828,r=-0.876,P＜0.05),in the inferior wall MI group,those wasn't significantly correlated with LVEF.Conclusions 3D speckle tracking echocardiography is a new noninvasive method that could accurately and quantitatively evaluate the regional wall motion abnormalities and global systolic function.AS may be a novel,comprehensive,accurate,and quantitative evaluation indicator of cardiac function.