心肌声学造影在经皮冠状动脉介入治疗后评估急性心肌梗死患者微循环灌注中的应用。
The application of myocardial contrast echocardiography in assessing microcirculation perfusion in patients with acute myocardial infarction after PCI.
机构信息
Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China.
Department of Radiology, Tongjiang People's Hospital, Tongjiang City, 156400, China.
出版信息
BMC Cardiovasc Disord. 2022 May 20;22(1):233. doi: 10.1186/s12872-021-02404-9.
BACKGROUND
To evaluate the myocardial microcirculation perfusion of patients with acute ST-segment elevation myocardial infarction (STEMI) with a different index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and analyse the value of MCE in predicting myocardial perfusion after PCI.
METHODS
Fifty-six patients with acute STEMI who underwent an emergency PCI were selected from October 2018 to October 2019 in our hospital. According to the IMR values measured during PCI treatment, the patients were divided into three groups. Traditional ultrasound and MCE were performed one week after PCI. The left ventricular ejection fraction (LVEF), ventricular wall motion score index (WMSI), A value, β value and A × β value (which refers to the patient's myocardial blood flow) were measured. The receiver operating characteristic curve was drawn to evaluate the effectiveness of the MCE parameters in the diagnosis of myocardial microcirculation perfusion disorders.
RESULTS
The results showed that there was no significant difference in the LVEF among the groups. The WMSI in Group 3 was statistically different from that in Groups 1 and 2 (P < 0.05), but there was no statistically significant difference in the WMSI between Groups 1 and 2. Among the three groups, the A value, β value and A × β value were significantly different (P < 0.05). According to Spearman's correlation analysis, the MCE quantitative parameters (i.e. the A value, β value and A × β value) were negatively correlated with the IMR value (r = -0.523, -0.471, -0.577, P < 0.01).
CONCLUSIONS
The A value, β value and A × β value were negatively correlated with the IMR value. Furthermore, MCE could be used to observe the myocardial perfusion in patients with acute STEMI after PCI and may be one of the indicators used to accurately evaluate myocardial microcirculation.
背景
通过心肌声学造影（MCE）评估经皮冠状动脉介入治疗（PCI）后不同微血管阻力（IMR）指数的急性 ST 段抬高型心肌梗死（STEMI）患者的心肌微循环灌注，并分析 MCE 预测 PCI 后心肌灌注的价值。
方法
选取 2018 年 10 月至 2019 年 10 月我院收治的 56 例行急诊 PCI 的急性 STEMI 患者，根据 PCI 术中测量的 IMR 值分为 3 组，于 PCI 术后 1 周内行传统超声及 MCE 检查，测量左心室射血分数（LVEF）、室壁运动评分指数（WMSI）、A 值、β 值及 A×β 值（代表患者心肌血流），绘制受试者工作特征曲线评价 MCE 参数对心肌微循环灌注障碍的诊断效能。
结果
结果显示，3 组间 LVEF 比较差异无统计学意义；WMSI 以第 3 组与第 1、2 组比较差异有统计学意义（P＜0.05），而第 1、2 组间比较差异无统计学意义；3 组间 A 值、β 值及 A×β 值比较差异均有统计学意义（P＜0.05）。Spearman 相关性分析显示，MCE 定量参数（A 值、β 值及 A×β 值）与 IMR 值呈负相关（r=-0.523、-0.471、-0.577，P＜0.01）。
结论
A 值、β 值及 A×β 值与 IMR 值呈负相关，MCE 可用于观察急性 STEMI 患者 PCI 后的心肌灌注情况，可能是准确评估心肌微循环的指标之一。
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