定量组织速度成像预测心肌梗死PCI 术后心功能不全的研究

目的:应用定量组织速度成像技术(QTVI)检测经皮冠状动脉介入治疗(PCI)后的ST段抬高的急性心肌梗死(STEMI)患者左心室收缩功能的改变;评价QTVI指标对该类患者未来发生心力衰竭的预测价值。方法:选择行急诊PCI术治疗的冠状动脉单支病变的急性心肌梗死患者,术后一周测量患者的左心室射血分数(LVEF),LVEF<50%者排除,LVEF≥50%者入选。共38例。并设正常对照组30例。入选者继续测二尖瓣环室间隔侧和左室侧壁侧QTVI曲线上心室收缩期速度峰值(Sa),并计算左室平均收缩期速度峰值(mean Sa)。术后12个月随访,查LVEF。结果:PCI术12个月后有17位患者LEVF<50%,21位患者LEVF≥50%。入选的STEMI者术后7天的左室平均Sa波峰值低于正常对照组。术后12个月出现LVEF减低(<50%)的患者,其术后7天的左室平均Sa波峰值低于PCI术12个月后LVEF正常的患者(P<0.01)。结论:通过QTVI检测二尖瓣环的运动速度能够早期发现单支病变所致的急性心肌梗死患者在急诊PCI术后的左心室功能受损;PCI术后LVEF正常的STEMI患者,术后7天QTVI测得的左室平均Sa波峰值减低可能预示着将来发展为LVEF减低的左心室收缩功能不全。

Quantitative Tissue Velocity Imaging as Predictor of Heart Failure in Patients with Acute ST Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Objective: To explore the change of left ventricular function in patients with acute ST elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI) by quantitative tissue velocity imaging(QTVI),To assess the predictive value of QTVI in heart failure in these patients.Methods: Patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study.38 selected patients had a normal left ventricular ejection fraction(LVEF)(≥50 %) assessed by left ventriculography at 7 days after PCI.Thirty healthy subjects were randomly selected.7 days after PCI,QTVI-derived peak systolic velocity(Sa) was measured at mitral annulus(septal and lateral),and mean peak velocity(mean Sa) was calculated by averaging data.Patients were followed up for 12 months.Echocardiography was done and LVEF was calculated in all patients at 12 months after PCI.Results: At 12 months after PCI there were 17 patients with LVEF<50 % and 26 patients with LEVF≥50 %.Mean Sa levels in STEMI patients were significantly lower than that in healthy subjects.Mean Sa levels in STEMI patients with reduced LVEF was significantly lower than that in STEMI patients with normal LVEF(P<0.01).Conclusion: QTVI enables early detection of left ventricular dysfunction in Patients with acute STEMI after PCI who had single vessel disease;The STEMI patients with normal LVEF who had lower mean Sa at 7 days after PCI,are at high risk for developing heart failure.