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目的:探讨实时三维超声心动图技术(realtime three dimensional echocardiography,RT-3DE)对评价急性心肌梗死(acute myocardial infarction,AMI)经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后左室收缩功能及同步性的临床应用价值。方法:选择30例左室急性前壁及前间壁心梗并进行急诊PCI术的患者和30例正常对照组,应用Philips IE33彩色多普勒超声成像仪对PCI术前及术后1个月的左心室功能指标进行二维常规超声检查及三维超声心动图检查,应用Q-lab6.0软件进行分析。结果:二维超声心动图显示AMI组术前左心室收缩末容量(ESV)及舒张末容量(EDV)较对照组比较明显增大(P<0.01),左心室射血分数(EF)较对照组明显减小(P<0.01);急性心肌梗死(AMI)组术后1个月左心室ESV及EDV较术前比较减小(P<0.05),左心室EF较术前增大(P<0.05);AMI组术后1个月左心室ESV及EDV较对照组比较增大(P<0.05),左心室EF较对照组减小(P<0.05);三维超声心动图的各参数比较,AMI组PCI术前梗死节段局部收缩末期容量(RESV)及局部舒张末期容量(REDV)较对照组增大(P<0.05),左心室梗死节段局部射血分数(REF)较对照组减小(P<0.05);AMI组患者梗死节段RESV及REDV术后1个月较术前比较减小(P<0.05),梗死节段REF较术前比较有所增大(P<0.05),AMI组术后1个月梗死节段RESV及REDV较对照组增大(P<0.05),梗死节段REF较对照组减小(P<0.05);左室16节段从QRS波起点到最小收缩容积时间的标准差和最大差值(Tmsvl6-SD、Tmsvl6-Dif)以及用R-R间期校正后的Tmsvl6-SD%(左室收缩不同步指数systolic dyssynchrony index,SDI)和Tmsvl6-Dif%较术前比较减小(p<0.05)。结论:PCI手术前、后应用RT-3DE能够准确评价左心室17节段的局部收缩功能及运动同步性,对AMI患者心功能的研究具有重要意义。
Objective: To investigate the effect of real-time three-dimensional echocardiography (RT-3DE) on left ventricular systolic function after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) And the clinical value of synchronization. Methods: Thirty patients with acute left anterior and anterior myocardial infarction who underwent emergency PCI and 30 normal control subjects were enrolled in this study. Philips IE33 color Doppler ultrasound imaging was used to evaluate the effect of PCI on preoperative and postoperative 1 month Left ventricular function parameters of two-dimensional conventional ultrasound and three-dimensional echocardiography, using Q-lab6.0 software for analysis. Results: Two-dimensional echocardiography showed that preoperative left ventricular end-systolic volume (ESV) and end-diastolic volume (EDV) in AMI group were significantly higher than those in control group (P <0.01), left ventricular ejection fraction (P <0.01). In the AMI group, the left ventricular ESV and EDV in the AMI group decreased compared with those before operation (P <0.05), while the left ventricular EF increased in the AMI group (P < 0.05). Compared with the control group, the left ventricular ejection fraction (ESV) and EDV increased (P <0.05) and the left ventricular EF decreased (P <0.05) in the AMI group at one month after surgery. Compared with the three-dimensional echocardiography, The AMI group had higher RESV and REDV than those of the control group (P <0.05), and the local ejection fraction (REF) of left ventricular infarction group was lower than that of the control group (P <0.05). In AMI group, the RESV and REDV in the infarct segment decreased compared with the preoperative one month after operation (P <0.05), and the REF in the infarct segment increased compared with that before operation (P <0.05) (P <0.05). The REF of infarction segment was lower than that of control group (P <0.05), and the amplitude of RESV and REDV in infarction segment of AMI group was significantly higher than that of control group Standard deviation and maximum difference of minimum systolic volume time (Tmsvl6-SD, Tmsvl6-Dif) (P <0.05) compared with preoperative Tmsvl6-SD% (systolic dyssynchrony index, SDI) and Tmsvl6-Dif% corrected by R-R interval. Conclusion: RT-3DE before and after PCI can accurately evaluate the local systolic function and motor synchrony of 17 segments of left ventricle. It is of great significance to study the cardiac function in patients with AMI.