孙思瑶,陈旗旗,孙巧冰,魏虹,陈娜,付婷婷,商志娟,孙颖慧,丛涛.无创心肌做功评估经皮冠状动脉介入治疗后急性ST段抬高型心肌梗死患者心肌节段微血管灌注[J].中国医学影像技术,2022,38(6):853~858
无创心肌做功评估经皮冠状动脉介入治疗后急性ST段抬高型心肌梗死患者心肌节段微血管灌注
Noninvasive myocardial work for evaluating myocardial segmental microvascular perfusion in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention
投稿时间:2021-09-09  修订日期:2022-01-24
DOI:10.13929/j.issn.1003-3289.2022.06.014
中文关键词:  心肌梗死  超声检查,介入性  超声心动描记术  经皮冠状动脉介入治疗  微血管灌注  心肌做功
英文关键词:myocardial infarction  ultrasonography, international  echocardiography  percutaneous coronary intervention  microvascular perfusion  myocardial work
基金项目:辽宁省自然科学基金(2019-ZD-0629)。
作者单位E-mail
孙思瑶 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
陈旗旗 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
孙巧冰 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
魏虹 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
陈娜 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
付婷婷 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
商志娟 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
孙颖慧 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021  
丛涛 大连医科大学附属第一医院心脏超声科, 辽宁 大连 116021 congtao1975@163.com 
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中文摘要:
      目的 观察无创心肌做功(MW)评估经皮冠状动脉介入治疗(PCI)后急性ST段抬高型心肌梗死(STEMI)患者心肌节段微血管灌注(MVP)的效能。方法 分析119例经PCI治疗的STEMI患者术后72 h内超声心动图及心肌超声造影(MCE)检查资料,评估心肌节段MVP水平,对比不同水平MVP心肌节段的纵向应变(LS)和心肌有用功(CMW)、无用功(WW)、MW指数(MWI)及MW率(MWE);以多因素logistic回归分析观察MVP减低的独立影响因素,以受试者工作特征(ROC)曲线分析其评估MVP减低的效能。结果 共纳入2 142个心肌节段,其中MVP正常组1 515个节段(造影剂恢复充盈时间≤4 s),延迟组321个节段(造影剂恢复充盈时间>4 s且<10 s),减低组306个节段(造影剂恢复充盈时间≥10 s);3组间心肌节段LS、CMW、WW、MWI和MWE总体及两两比较差异均有统计学意义(P均<0.001)。将MVP正常及延迟者归为MVP未减低组,其与减低组间心肌节段LS、CMW、WW、MWI及MWE差异均有统计学意义(P均<0.001)。MWI[OR=1.00,95%CI(1.00,1.00),P=0.023]、MWE[OR=0.98,95%CI(0.97,1.00),P=0.010]、CMW[OR=1.00,95%CI(1.00,1.00),P<0.001]均为MVP减低的独立影响因素,其评估MVP减低的曲线下面积(AUC)分别为0.856、0.853及0.877,CMW大于MWI、MWE (Z=5.246、2.307,P均<0.05)。结论 无创MW可有效评估PCI后STEMI患者心肌节段MVP。
英文摘要:
      Objective To observe the efficacy of noninvasive myocardial work (MW) for evaluating myocardial segmental microvascular perfusion (MVP) in patients with acute ST-elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Methods Data of 119 acute STEMI patients who underwent PCI as well as echocardiography and myocardial contrast echocardiography (MCE) within 72 h after PCI were retrospectively analyzed. MVP of myocardial segments were evaluated, and longitudinal strain (LS), constructive myocardial work (CMW), wasted work (WW), myocardial work index (MWI) and myocardial work efficiency (MWE) in myocardial segments with different levels of MVP were compared. Multivariable logistic regression analysis was performed to screen independent impact factors of reduced MVP, and the receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the impact factors for assessing reduced MVP.Results Totally 2 142 myocardial segments were enrolled, including 1 515 segments with normal MVP (replenishment of contrast ≤ 4 s, normal group), 321 with delayed MVP (replenishment of contrast >4 s and <10 s, delayed group) and 306 with reduced MVP (replenishment of contrast ≥ 10 s, reduced group).Significant differences of LS, CMW, WW, MWI and MWE (all P<0.001) were found among 3 groups and between each two groups. When classified those of normal MVP group and delayed MVP group into non-reduced MVP group, significant differences of LS, CMW, WW, MWI and MWE were noticed between non-reduced MVP group and reduced MVP group (all P<0.001). MWI (OR=1.00, 95%CI[1.00, 1.00], P=0.023), MWE (OR=0.98, 95%CI[0.97, 1.00], P=0.010), CMW (OR=1.00, 95%CI[1.00, 1.00], P<0.001) were all independent impact factors of reduced MVP, with the area under the curve (AUC) of 0.856, 0.853 and 0.877, respectively, of CMW was higher than of MWI and MWE (Z=5.246, 2.307, both P<0.05).Conclusion Noninvasive MW was effective for evaluating myocardial segmental MVP in STEMI patients after PCI.
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