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三维斑点追踪超声心动图评价通心络治疗急性 ST 段抬高型心肌梗死经皮冠状动脉介入治疗后患者左心室功能。

Three-dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention following Tongxinluo treatment.

机构信息

Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China.

出版信息

J Clin Ultrasound. 2022 Nov;50(9):1229-1239. doi: 10.1002/jcu.23279. Epub 2022 Aug 31.

Abstract

OBJECTIVE

Bying comparing the correlation between three-dimensional speckle tracking echocardiography (3D-STE) and troponin I (cTn I), three-dimensional left ventricular ejection fraction (3D-LVEF), to explore the 3D-STE to evaluate the left ventricle of patients with acute ST-segment elevation myocardial infarction (AMI) after percutaneous coronary intervention (PCI) following routine treatment with Tongxinluo drugs.

METHODS

Altogether, 61 patients with AMI and 30 healthy adults were selected, and the patients were divided into the routine group and the Tongxinluo group. The serum creatine kinase isoenzyme (CK-MB) and troponin I (cTn I) levels were detected in all patients after admission. All patients underwent PCI, and routine echocardiography and 3D-STE assessments were performed for each group 72 h after PCI and 12 months after PCI to obtain the following left ventricular-related functional parameters: left ventricular end-diastolic diameter (LVEDD), end-ventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular short axis shortening fraction (LVFS), Simpson's left ventricular ejection fraction (Simpson's LVEF), three-dimensional left ventricular ejection fraction (3D-LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist angle (LVtw), Torsion (Tor), peak strain dispersion (PSD), and myocardial comprehensive index (MCI). The same parameters were collected in the control group, the results were compared. The correlation analysis between 3D-STE parameters and 3D-LVE, cTn I was performed. A total of 10 individuals were selected for repeatability testing.

RESULTS

Compared with the control group, the LVFS, LVEF (Simpson), 3D-LVEF, GLS, GCS, LVtw, Tor, and MCI significantly decreased in patients with STEMI after PCI, while the PSD significantly increased (p < 0.05). Compared with the values 72 h after PCI, the LVEDD, LVFS, LVEF (Simpson), 3D-LVEF, GLS, GCS, LVtw, Tor, and MCI significantly increased at 12 m after PCI, while PSD significantly decreased (p < 0.05). No significant difference was observed between the two groups at 72 h after PCI (p > 0.05). At 12 months after PCI, the LVEF, GLS, GCS, LVtw, Tor, and MCI of the Tongxinluo group were higher than those of the routine group. The PSD was significantly lower in the Tongxinluo group (p < 0.05). MCI and 3D-LVEF, cTn I have the strongest correlation and the highest consistency, which can best reflect the changes in the left ventricular function in patients with AMI after PCI.

CONCLUSION

3D-STE can be used to evaluate the protective effect of Tongxinluo on the left ventricular function in patients with AMI after PCI.

摘要

目的

通过比较三维斑点追踪超声心动图(3D-STE)与肌钙蛋白 I(cTn I)的相关性,以及三维左心室射血分数(3D-LVEF),探讨 3D-STE 评估急性 ST 段抬高型心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后常规使用通心络药物治疗的左心室功能。

方法

选取 61 例 AMI 患者和 30 例健康成年人,将患者分为常规组和通心络组。所有患者入院后检测血清肌酸激酶同工酶(CK-MB)和肌钙蛋白 I(cTn I)水平。所有患者均进行 PCI,PCI 后 72 h 和 12 个月分别对两组进行常规超声心动图和 3D-STE 评估,以获得以下左心室相关功能参数:左心室舒张末期直径(LVEDD)、室间隔舒张末期厚度(IVSD)、左心室后壁舒张末期厚度(LVPWD)、左心室短轴缩短分数(LVFS)、辛普森左心室射血分数(Simpson's LVEF)、三维左心室射血分数(3D-LVEF)、整体纵向应变(GLS)、整体圆周应变(GCS)、左心室扭转角度(LVtw)、扭转(Tor)、峰值应变离散度(PSD)和心肌综合指数(MCI)。在对照组中收集相同的参数,比较结果。对 3D-STE 参数与 3D-LVE、cTn I 进行相关性分析。对 10 名个体进行重复性测试。

结果

与对照组相比,PCI 后 STEMI 患者的 LVFS、LVEF(Simpson)、3D-LVEF、GLS、GCS、LVtw、Tor 和 MCI 显著降低,而 PSD 显著升高(p<0.05)。与 PCI 后 72 h 相比,PCI 后 12 个月时 LVEDD、LVFS、LVEF(Simpson)、3D-LVEF、GLS、GCS、LVtw、Tor 和 MCI 显著增加,而 PSD 显著降低(p<0.05)。PCI 后 72 h 时两组间无显著差异(p>0.05)。PCI 后 12 个月时,通心络组的 LVEF、GLS、GCS、LVtw、Tor 和 MCI 高于常规组,PSD 明显低于常规组(p<0.05)。MCI 和 3D-LVEF、cTn I 相关性最强,一致性最高,能最好地反映 PCI 后 AMI 患者左心室功能的变化。

结论

3D-STE 可用于评估通心络对 PCI 后 AMI 患者左心室功能的保护作用。

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