Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, China.
Department of Cardiovascular Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China.
Ann Palliat Med. 2021 Jul;10(7):8034-8042. doi: 10.21037/apm-21-1540.
Percutaneous coronary intervention (PCI) has become increasingly mature and has gradually become the main treatment for coronary heart disease (CHD). However, evaluation of myocardial reperfusion after PCI remains a major clinical challenge. This study aimed to explore the VVI technique in evaluating the effect, prognosis, and follow-up of CHD patients after percutaneous coronary intervention. We performed a quantitative analysis of left ventricular myocardial contractile strain and dyssynchrony before and after stent implantation in patients by VVI.
Thirty-five patients diagnosed with CHD who underwent percutaneous coronary stenting (PCI) in the Department of Cardiovascular Medicine, Affiliated Hospital of Jiangnan University from March 2019 to October 2020 were selected as the case group. Continuous dynamic two-dimensional images of the patient's left ventricle were analyzed using VVI at 1 day before PCI (group A), 7 days after PCI (group B), and 30 days after PCI (group C). The patients' left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricle ejection fraction (LVEF), peak longitudinal strain, and peak radial strain of myocardial contraction were measured. The VVI images of 35 healthy subjects who underwent physical examination in the outpatient department of our hospital from March 2019 to October 2020 were selected as controls.
There were no significant differences in the LVEF, LVEDD, and LVESD between the case and control groups (P>0.05). The peak systolic longitudinal and radial strain values at 1 month after treatment were higher than those before treatment. The differences among myocardial segments were statistically significant, except for the apical septum, base anterior, apical anterior, and base inferior segments (P<0.05). The peak systolic longitudinal and radial strain values at 1 week after treatment were not significantly different from those at 1 month after treatment, except for the base anterior septum, mid anterior, posterior, and inferior myocardial segments (P>0.05).
VVI technology can comprehensively and objectively evaluate the overall and local myocardial function of the left ventricle, thereby providing a novel method for the clinical treatment of CHD as well as the evaluation of curative effect and prognosis.
经皮冠状动脉介入治疗（PCI）已日趋成熟，逐渐成为冠心病（CHD）的主要治疗手段。然而，PCI 后心肌再灌注的评估仍然是一个主要的临床挑战。本研究旨在探讨 VVI 技术在评估经皮冠状动脉介入治疗后 CHD 患者的疗效、预后和随访中的作用。我们通过 VVI 对患者支架植入前后的左心室心肌收缩应变和不同步进行定量分析。
选择 2019 年 3 月至 2020 年 10 月在江南大学附属医院心血管内科行经皮冠状动脉支架植入术（PCI）的 35 例 CHD 患者为病例组。分别于 PCI 前 1 天（A 组）、PCI 后 7 天（B 组）和 PCI 后 30 天（C 组）采用 VVI 分析患者左心室连续动态二维图像。测量患者左心室舒张末期直径（LVEDD）、左心室收缩末期直径（LVESD）、左心室射血分数（LVEF）、心肌收缩的峰值纵向应变和峰值径向应变。选取 2019 年 3 月至 2020 年 10 月我院门诊体检的 35 例健康受试者的 VVI 图像作为对照组。
病例组和对照组的 LVEF、LVEDD 和 LVESD 比较差异均无统计学意义（P>0.05）。治疗后 1 个月的收缩期峰值纵向和径向应变值高于治疗前，各心肌节段间差异均有统计学意义，除心尖间隔、基底前、心尖前和基底下节段外（P<0.05）。治疗后 1 周的收缩期峰值纵向和径向应变值与治疗后 1 个月比较，除基底前间隔、中间前、后和下心肌节段外（P>0.05），差异均无统计学意义。
VVI 技术可以全面、客观地评价左心室整体及局部心肌功能，为 CHD 的临床治疗及疗效和预后评价提供一种新的方法。
