二维纵向应变对冠心病患者经体外心脏震波治疗后左心室收缩功能变化的效果评价

目的:应用二维纵向应变评价冠心病患者经体外心脏震波治疗后,左心室收缩功能的变化。方法:随机选择70例冠心病患者,其中38例接受体外心脏震波治疗(CSWT,CSWT组),32例不接受CSWT(对照组)。两组患者分别于治疗前及治疗后3个月时完成双核素心肌同步显像。两组患者均在治疗前及治疗后3个月、6个月行常规超声心动图检查,分别测得左心室射血分数(LVEF)、左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、左房前后径(LAD)。同时采集左心室心尖长轴(APLAX)、心尖四腔(A4C)、心尖两腔(A2C)切面动态图像,应用二维纵向应变技术获取左心室整体收缩期纵向应变值(GLS)、左心室心尖长轴整体应变(GLS-APLAX)、左心室心尖四腔整体应变(GLS-A4C)、左心室心尖两腔整体应变(GLS-A2C)。结果:CSWT组治疗后3个月核素心肌灌注显像总计分与代谢显像总计分均较治疗前改善(P<0.05);对照组治疗后上述指标无明显改善。CSWT组治疗后3个月LVEF、LVEDD、LVESD、LAD与治疗前差异均无统计学意义;CSWT组治疗后6个月LVEF较治疗前增加,LVEDD、LVESD、LAD均较治疗前减小,差异均有统计学意义(P<0.05)。对照组治疗前后LVEF、LVEDD、LVESD、LAD差异均无统计学意义。CSWT组治疗后3个月和6个月的GLS、GLS-APLAX、GLS-A4C、GLS-A2C均较治疗前升高(P<0.05);对照组治疗前后GLS、GLS-APLAX、GLS-A4C、GLS-A2C差异均无统计学意义。结论:体外CSWT能改善冠心病患者左心室心肌灌注及代谢、二维纵向应变及收缩功能。二维纵向应变的改善早于LVEF,能更早发现左心室收缩功能的变化。

Evaluation of left ventricular systolic function in patients with coronary artery disease after cardiac shock wave therapy by two-dimensional longitudinal strain

Objective: To evaluate the systolic function of left ventricular in patients with coronary artery disease (CAD) after cardiac shock wave therapy (CSWT) by two-dimensional longitudinal strain. Methods: A total of 70 patients with CAD were randomly selected, 38 patients were included in the CSWT group, and 32 patients who did not receive CSWT were included in the control group. The patients in the two groups completed dual-nuclides myocardial simultaneous imaging before and 3 months after therapy. The patients in the two groups performed routine echocardiography before, and 3 and 6 months after therapy. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left atrial diameter (LAD) were measured respectively. The apical long axis (APLAX) view, apical four-chamber (A4C) view, apical two-chamber (A2C) view of left ventricle were collected, and the left ventricular global longitudinal peak systolicstrain (GLS)and GLS-APLAX, GLS-A4C, GLS-A2C were accquired by two-dimensional longitudinal strain. Results: The total score of myocardial perfusion imaging and metabolic imaging in the CSWT group improved 3 months after therapy than before therapy (P<0.05). There was no significant improvement in the above indexes in the control group after therapy. There was no statistically significant difference in LVEF, LVEDD, LVESD, and LAD in the CSWT group 3 months after therapy. Compared to before therapy, LVEF increased, whereas LVEDD, LVESD, and LAD decreased in the CSWT group 6 months after therapy (P<0.05). There was no significant difference in LVEF, LVEDD, LVESD, and LAD in the control group before and after therapy. GLS, GLS-APLAX, GLS-A4C, and GLS-A2C all increased in the CSWT group 3 and 6 months after therapy (P<0.05). There was no significant difference in GLS, GLS-APLAX, GLS-A4C, and GLS-A2C in the control group before and after therapy. Conclusions: CSWT can improve myocardial perfusion and metabolism, two-dimensional longitudinal strain, and the systolic function of the left ventricle, and the improvement of the two-dimensional longitudinal strain may be earlier than LVEF.