实时三维超声心动图定量评价冠状动脉介入治疗术后左心功能的研究

摘要

目的:探讨实时三维超声心动图(RT-3DE)在评价经皮冠状动脉介入治疗(PCI)术前后患者左心室功能的价值.方法:选择成功接受PCI治疗的患者30例作为冠心病组,无冠状动脉狭窄者20例作为正常对照组,应用RT-3DE对冠心病组于术前3-5天、术后3天及术后1个月测量左室舒张末容积(EDV)、左室收缩末容积(ESV)、左心室射血分数(EF)、峰值射血率(PER)、峰值充盈率(PFR)、达到最小收缩容积时间的标准差(Tmsv16-SD)及最大差值(Tmsv16-Dif),对照组与冠心病组的测值进行比较,PCI术前后测值进行比较.结果:病例组术前EDV、ESV、Tmsv16-SD、Tmsv16-Dif显著增加(P<0.01),EF、PER、PFR显著减小(P<0.01);与术前比较,患者术后EDV、ESV、Tmsv16-SD、Tmsv16-Dif显著减小,整体EF、PER、PFR显著增加(P<0.01).结论:冠心病患者的左心室功能可发生重构,PCI能逆转其重构,RT-3DE可准确评价PCI术后患者左心室功能的逆转.%Objective: To assess the value of real-time three-dimensional echocardiography (RT-3DE) in the evaluation of left ventricular function in patients with coronary artery disease(CAD) after percutaneous coronary intervention(PCI).Methods:RT-3DE was performed in 30 patients who accepted PCI treatment successfully and 20 normal subjects who had no coronary artery stenosis.RT-3DE was performed and three-dimensional image data were analyzed.Seties of left ventricular parameters were measured in 3～5 days pre-, 3 days post- and 1 month post-operation.Left ventricular end-diastolic volume(EDV), endsystolic volume(ESV), ejection fraction(EF), the peak ejection rate(PER), peak filling rate(PFR), the time to the point with minimal systolic volume (Tmsv) in 16 segments standard deviation and the maximal difference of time (Tmsvl6-SD, Tmsvl6-Dif).These parameters were respectively compared.Results: Compared with normal subjects, EDV, ESV, Tmsvl6-SD, Tmsvl6-Dif were significantly increased(P＜0.0l).EF, PER and PFR in patients group were significantly decreased(P＜0.0l).Compared with pre-operation, EDV, Tmsv16-SD, Tmsv16-Dif were significantly decreased respectively.Meanwhile whole EF, PER and PFR were significantly increased after PCI.Conclusion: Left ventricular remodeling could be found in patients with CAD.PCI might reverse left ventricular remodeling somewhat.RT-3DE could be a new corrected valuable method of evaluating left ventricular remodeling and reverse remodeling in patients with CAD pre- and post-PCI.