二维应变技术分析急性心肌梗死患者左心室收缩期多维形变

目的 应用二维应变(2DS)技术定量观察非ST段抬高型及ST段抬高型急性心肌梗死患者左心室收缩期心肌的应变和心室扭转,探讨不同透壁程度心肌梗死的多维形变特征。方法 观察对象包括非ST段抬高型急性心肌梗死患者(A组)13例,ST段抬高型急性心肌梗死无室壁瘤形成患者(B组)41例,ST段抬高型急性心肌梗死有室壁瘤形成患者(C组)8例和正常人(D组)30名。应用2DS分析获得经皮冠状动脉介入术后1周及3个月A、B、C组患者和D组左心室收缩期整体纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)及扭转角度(Twist)。结果 术后1周A、B、C组 GLS、GRS、GCS、Twist均减低,且减低程度C组>B组>A组,与D组比较差异均有统计学意义(P均<0.05)。术后3个月时各组上述参数均得到改善,A组GRS、GCS最为明显,与D组比较差异无统计学意义(P>0.05);C组 GLS、GCS虽有改善,与术后1周时比较差异无统计学意义(P>0.05)。结论 综合观察左心室多维形变指标能够反映急性心肌梗死的透壁程度,对判断病情及评价预后具有重要意义。

Investigation on myocardial systolic multi-dimensional deformation of left ventricle in patients with ST-segment elevation acute myocardial infarction by using two-dimensional strain

Objective To explore the transmural extent of myocardial necrosis by assessment of myocardial systolic multi-dimensional deformation in non ST-segment elevation acute myocardial infarction (NSTEAMI) and ST-segment elevation acute myocardial infarction (STEAMI) using two-dimensional strain (2DS). Methods Thirteen patients with NSTEAMI (group A), 49 patients with STEAMI (divided into non ventricular aneurysm group (group B, n=41) and ventricular aneurysm group (group C, n=8) according to whether ventricular aneurysm formed or not and 30 normal controls (group D) were enrolled. All patients underwent percutaneous coronary intervention (PCI). The end systolic left ventricular global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS) and twist angle were obtained and calculated with 2DS for group A, B, C 1 week and 3 months after PCI and group D. Results Compared with group D, GLS, GRS, GCS and Twist decreased in group A, B, C 1 week after PCI (all P<0.05), the degrees of reduction were group C>B>A.Three months after PCI, those indexes increased gradually, GRS, GCS of group A were not statistical different compared with those of group D (P>0.05), while GLS, GCS increased, but were not significantly different compared with those 1 week after PCI in group C (P>0.05). Conclusion Myocardial systolic multi-dimensional deformation can contribute to estimation of transmural extent of necrosis and evaluation on the improvement after PCI in patients with NSTEAMI and STEAMI.