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应用整体纵向应变成像评估择期经皮冠状动脉介入治疗对稳定型冠状动脉疾病患者轻微左心室收缩功能障碍的影响。

Effects of Elective Percutaneous Coronary Intervention on Subtle Left Ventricular Systolic Dysfunction in Patients With Stable Coronary Artery Disease as Assessed by Global Longitudinal Strain Imaging.

作者信息

Venu Swargam, Iyer Ramnath Venkitasubramonia, Dash Prabath Kumar

机构信息

Cardiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND.

Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, IND.

出版信息

Cureus. 2024 Dec 5;16(12):e75133. doi: 10.7759/cureus.75133. eCollection 2024 Dec.

Abstract

Aim The study aimed to detect subtle left ventricular (LV) systolic dysfunction, reflected by abnormal global longitudinal strain (GLS), in patients with stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and to evaluate any improvement in GLS at 24 hours and six months post-PCI. Methods A total of 94 patients with stable CAD scheduled for elective PCI at our hospital were evaluated using conventional 2D echocardiography and GLS prior to the procedure. Follow-up assessments were conducted at 24 hours and six months post-PCI. Results Our study revealed evidence of subclinical LV dysfunction in the form of reduced baseline GLS (-16.72 ± 1.98) despite a normal ejection fraction (59.21 ± 2%). Baseline GLS showed a significant correlation with the severity of CAD, declining progressively with an increasing number of stenotic coronary vessels. Notably, there was significant improvement in subclinical LV dysfunction following PCI, as evidenced by enhanced GLS values at the six-month follow-up (-21.87 ± 1.70; p < 0.001). Among patients stratified into single-vessel disease (SVD, 63.8%), double-vessel disease (29.8%), and triple-vessel disease (3VD, 6.4%), GLS improved significantly at both 24 hours and six months post-PCI compared to baseline. Conclusions Patients with stable CAD, normal LVEF, and no regional wall motion abnormalities on 2D echocardiography were found to exhibit subtle LV dysfunction as detected by GLS. GLS parameters showed significant improvement following successful PCI. The degree of GLS impairment progressively worsened with the severity of CAD, increasing from SVD to 3VD.

摘要

目的 本研究旨在检测接受经皮冠状动脉介入治疗(PCI)的稳定型冠状动脉疾病(CAD)患者中,由异常整体纵向应变(GLS)反映的轻微左心室(LV)收缩功能障碍,并评估PCI术后24小时和6个月时GLS的改善情况。方法 对我院计划进行择期PCI的94例稳定型CAD患者在手术前使用传统二维超声心动图和GLS进行评估。在PCI术后24小时和6个月进行随访评估。结果 我们的研究发现,尽管射血分数正常(59.21±2%),但基线GLS降低(-16.72±1.98),存在亚临床LV功能障碍的证据。基线GLS与CAD的严重程度显著相关,随着狭窄冠状动脉血管数量的增加而逐渐下降。值得注意的是,PCI术后亚临床LV功能障碍有显著改善,在6个月随访时GLS值升高(-21.87±1.70;p<0.001)证明了这一点。在分为单支血管病变(SVD,63.8%)、双支血管病变(29.8%)和三支血管病变(3VD,6.4%)的患者中,与基线相比,PCI术后24小时和6个月时GLS均显著改善。结论 发现二维超声心动图显示LVEF正常且无节段性室壁运动异常的稳定型CAD患者存在GLS检测到的轻微LV功能障碍。成功的PCI术后GLS参数有显著改善。GLS受损程度随CAD严重程度逐渐加重,从SVD到3VD逐渐增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64c1/11700025/b44b4849f466/cureus-0016-00000075133-i01.jpg

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