天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (2): 124-127.doi: 10.11958/20191819

• 临床研究 • 上一篇    下一篇

二维斑点追踪成像技术评价缺血性二尖瓣反流患者PCI 治疗前后乳头肌功能的变化

姜薇，孙微，关莹莹，程小磊   

  1. 沈阳医学院附属第二医院超声科（邮编110002）
  • 收稿日期:2019-06-18 修回日期:2019-09-16 出版日期:2020-02-15 发布日期:2020-02-15
  • 通讯作者: 姜薇 E-mail:cabin@126.com

2D-STI technique in evaluating the changes of papillary muscle function before and after PCI in patients with ischemic mitral regurgitation

JIANG Wei, SUN Wei, GUAN Ying-ying, CHENG Xiao-lei   

  1. Department of Ultrasonography, the Second Hospital of Shenyang Medical College, Shenyang 110002, China
  • Received:2019-06-18 Revised:2019-09-16 Published:2020-02-15 Online:2020-02-15
  • Contact: JIANG Wei E-mail:cabin@126.com

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摘要： 摘要：目的 应用超声二维斑点追踪成像技术（2D-STI）定量评估缺血性二尖瓣反流（IMR）患者经皮冠状动脉介 入术（PCI）前后二尖瓣乳头肌功能的变化情况。方法 选取急性心肌梗死伴轻中度IMR患者72例，根据心肌梗死部 位将患者分为前壁心肌梗死组（Ant-MI组）33例和下壁心肌梗死组（Inf-MI组）39例，于PCI术前48 h内及PCI术后3 个月行常规超声心动图及2D-STI检查。测量常规超声心动图参数包括左室舒张末期内径（LVEDd）、左室舒张和收 缩末期容积（LVEDV/LVESV）、左室射血分数（LVEF）及二尖瓣反流容积；2D-STI参数包括二尖瓣前外、后内乳头肌 纵向应变峰值（APM-S、PPM-S）及值达峰时间（APM-T、PPM-T），计算达峰时间差（DT）＝∣APM-T－PPM-T∣。结果 2组患者LVEDd、LVEDV、LVESV、LVEF及二尖瓣反流容积差异均无统计学意义。与PCI术前相比，2组患者PCI术 后LVESV降低，LVEF升高，二尖瓣反流容积减少（P＜0.05）；而LVEDV、LVEDd无明显变化（P＞0.05）。Ant-MI组术 前及术后∣APM-S∣均低于Inf-MI组，∣PPM-S∣均高于Inf-MI组（P＜0.05）。与术前相比，Ant-MI组患者术后∣APM-S∣升 高，DT降低（P＜0.05），∣PPM-S∣、APM-T及PPM-T无明显变化（P＞0.05）；Inf-MI组患者术后∣PPM-S∣升高，DT降低 （P＜0.05），∣APM-S∣、APM-T及PPM-T无明显变化（P＞0.05）。结论 2D-STI技术可较敏感地评价二尖瓣乳头肌功 能，PCI可明显改善轻中度IMR患者乳头肌的功能，减轻反流程度，改善左心室重构。

关键词: 二维, 超声心动图, 斑点追踪成像, 缺血性二尖瓣反流, 急性心肌梗死, 冠状动脉介入术

Abstract: Abstract: Objective To evaluate the papillary muscle function in patients with ischemic mitral regurgitation (IMR) before and after percutaneous coronary intervention(PCI) using two-dimensional speckle tracking imaging (2D-STI) technique. Methods Seventy-two patients with myocardial infarction were selected and divided into 2 groups, the anterior myocardial infarction group (Ant-MI group, n=33) and the inferior myocardial infarction group (Inf-MI group, n=39). The papillary muscle function was evaluated by echocardigraphy and 2D-STI technique 48 h before PCI and 3 months after PCI. Data of the left ventricular end-diastolic diameter (LVEDd), the left ventricular end-diastolic and end-systolic volume (LVEDV / LVESV), the left ventricular ejection fraction (LVEF) and the mitral regurgitation volume were measured by echocardiography. Data of the longitudinal strain (APM-S, PPM-S), the peak time (APM-T, PPM-T) and the delay time (DT=|APM-T - PPM-T|) of mitral anterior and posterior papillary muscles were measured by 2D-STI technique. Results There were no significant differences in LVEDd, LVEDV, LVESV, LVEF, and mitral regurgitation volume between two groups. Compared with the PCI opertion before, the LVEF was significantly increased, the LVESV and the mitral regurgitation volume were significantly decreased after PCI opertion in both groups (P＜0.05)，and there were no significant changes in LVEDV and LVEDd (P＞0.05). The values of |APM-S| was lower and the |PPM-S| was higher in Ant-MI group than those of Inf-MI group, neither before nor after PCI opertion (P＜0.05). After PCI operation: the |APM-S| was signigicantly increased and the DT was significantly decreased in Ant-MI group (P＜0.05). There were no signigicant changes in |PPM-S|, APM-T and PPM-T (P＞0.05). The |PPM-S| was signigicantly increased and DT was significantly decreased in Inf-MI group (P＜0.05), and there were no significant changes in |APM-S|, APM-T and PPM-T (P＞0.05). Conclusion The 2D-STI technology can be used to evaluate the function of mitral papillary muscles. PCI can significantly improve the papillary muscle function in patients with mild to moderate IMR, reduce the reflux and improve the left ventricular remodeling.

Key words: two-dimeonsional, echocardiography, speckle tracking imaging, ischemic mitral regurgitation, myocardial infarction, percutaneous coronary intervention