二维超声心动图联合M型超声对检测非ST段抬高型心肌梗死室壁运动异常的评估
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摘要
目的探讨二维超声心动图(2DE)联合M型超声对非ST段抬高型心肌梗死(NSTEMI)室壁运动异常的评估价值。方法选取我院收治的122例NSTEMI患者为研究对象。所有患者首先接受2DE超声检查,对于2DE左心室节段室壁运动异常(2DE-RWMA)阳性的患者联合M型超声检查。最后,所有NSTEMI患者接受冠状动脉造影(CAG)检查。CAG检查在超声心动图后48小时内完成。结果 2DE-RWMA能够检出约53.57%冠状动脉病变,漏诊率约46.43%。2DE-RWMA阳性对三支冠状动脉受累的NSTEMI检出率显著高于三支以下受累的NSTEMI患者(P<0.05);2DE-RWMA对冠状动脉狭窄≥90%的检出率显著高于狭窄程度<90%的NSTEMI患者(P<0.05);2DERWMA对NSTEMI的检出率与受累冠状动脉数量和冠状动脉狭窄程度均呈正比(P<0.05);2DE-RWMA阳性患者经M型超声检查发现,WTF-RWMA阳性者左室室壁节段运动幅度和各节段室壁收缩期增厚率明显增加(均P<0.05)。结论 2DE联合M型超声能够敏感地发现NSTEMI引起的心肌缺血和左心室室壁运动异常,显著提高NSTEMI的早期检出率。
Objective To assess the value of two-dimensional echocardiography( 2 DE) combined with M-mode ultrasound in evaluating the wall motion abnormality of non-ST-segment elevation myocardial infarction( NSTEMI). Methods 122 patients with NSTEMI admitted to our hospital were selected as study subjects. Firstly,patients with NSTEMI underwent the examination of 2 DE ultrasonography; patients with positive regional wall motion abnormality( 2 DE-RWMA) were combined with Mmode ultrasound. All NSTEMI patients also underwent coronary angiography( CAG) examination. The CAG examination was performed within 48 hours after the echocardiogram. Results 2 DE-RWMA could detect about 53. 57% of coronary artery lesions,and the missed diagnosis rate was about 46. 43%. The detection rate of 2 DE-RWMA positive for NSTEMI in three coronary artery lesions was significantly higher than that in NSTEMI( P < 0. 05). The detection rate of 2 DE-RWMA in coronary artery stenosis greater than or equal to 90% was significantly higher than that of NSTEMI in which the degree of stenosis was less than 90%( P < 0. 05). The detection rate of NDEEMI by 2 DE-RWMA was positively correlated with the number of involved coronary arteries and coronary artery stenosis( P < 0. 05). In 2 DE-RWMA-negative patients,M-mode ultrasonography revealed that the left ventricular wall motion amplitude and systolic thickening rate of each segment of wall thickening rate( WTF)-RWMA-positive patients were significantly increased( all P < 0. 05). Conclusions 2 DE combined with M-mode ultrasound can sensitively detect NSTEMI-induced myocardial ischemia and left ventricular wall motion abnormalities,and significantly increase the early detection rate of NSTEMI.
Objective To assess the value of two-dimensional echocardiography( 2 DE) combined with M-mode ultrasound in evaluating the wall motion abnormality of non-ST-segment elevation myocardial infarction( NSTEMI). Methods 122 patients with NSTEMI admitted to our hospital were selected as study subjects. Firstly,patients with NSTEMI underwent the examination of 2 DE ultrasonography; patients with positive regional wall motion abnormality( 2 DE-RWMA) were combined with Mmode ultrasound. All NSTEMI patients also underwent coronary angiography( CAG) examination. The CAG examination was performed within 48 hours after the echocardiogram. Results 2 DE-RWMA could detect about 53. 57% of coronary artery lesions,and the missed diagnosis rate was about 46. 43%. The detection rate of 2 DE-RWMA positive for NSTEMI in three coronary artery lesions was significantly higher than that in NSTEMI( P < 0. 05). The detection rate of 2 DE-RWMA in coronary artery stenosis greater than or equal to 90% was significantly higher than that of NSTEMI in which the degree of stenosis was less than 90%( P < 0. 05). The detection rate of NDEEMI by 2 DE-RWMA was positively correlated with the number of involved coronary arteries and coronary artery stenosis( P < 0. 05). In 2 DE-RWMA-negative patients,M-mode ultrasonography revealed that the left ventricular wall motion amplitude and systolic thickening rate of each segment of wall thickening rate( WTF)-RWMA-positive patients were significantly increased( all P < 0. 05). Conclusions 2 DE combined with M-mode ultrasound can sensitively detect NSTEMI-induced myocardial ischemia and left ventricular wall motion abnormalities,and significantly increase the early detection rate of NSTEMI.
引文
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[9]梁鸿彬,郭谦,张新禄,等.血管内超声指导急性冠脉综合征患者冠状动脉非左主干临界病变治疗的临床效果[J].南方医科大学学报,2017,37(5):707-711.
[10]赵磊磊,董平栓,王可,等.血管内超声在ST段抬高型心肌梗死临界病变急诊介入治疗中的应用[J].中国医学影像学杂志,2016,7(12):519-523.
[11]马春燕,李楠,刘爽,等.二维斑点追踪检测心肌跨壁应变梯度在非ST段抬高型心肌梗死中的应用[J].中国医学影像技术,2013,2(29):217-220.
[12]Basra SS,Virani SS,Paniagua D,et al.Acute coronary syndromes:unstable angina and non-ST elevation myocardial infarction[J].Cardiol Clin,2014,32(3):353-370.
[13]朱红涛,邱林林,李斌义,等.冠状动脉急性完全闭塞的不典型心电图分析[J].临床心血管病杂志,2017,33(9):870-874.
[2]鄢磊,阮琴韵,屈朝阳,等.二维超声心动图检测非ST段抬高型心肌梗死节段室壁运动异常的价值[J].中国介入影像与治疗,2017,4(14):233-237.
[3]leri M1,GürayU,Yetkin E,et al.A new risk scoring model for prediction of poor coronary collateral circulation in acute non-ST-elevation myocardial infarction[J].Cardiol J,2016,23(1):107-113.
[4]禹子清,陆浩,杨茗,等.心电图以急性前间壁ST段抬高型心肌梗死为表现的急性心肌炎一例[J].上海医学,2015,1(38):927-928.
[5]李宗庄,吴强,刘志琴,等.心肌坏死生化标志物对多发性肌炎和非ST段抬高型心肌梗死的鉴别诊断价值[J].临床心血管杂志,2017,33(1):27-29.
[6]陈海燕,姜丽萍.老年急性非ST段抬高型心肌梗死患者心血管不良事件的发生及影响因素[J].中国老年学杂志,2017,6(37):2946-2948.
[7]金莲锦,李罡,胡春阳,等.心肌声学造影评价非ST段抬高型心肌梗死患者PCI术后心功能[J].中国老年学杂志,2016,10(36):5030-5031.
[8]Hryhoriy K.Peculiarities of heart rate in the patients with unstable angina and non-ST elevation myocardial infarction and concomitant diabetes mellitus type 2[J].Wiad Lek,2016,69(3 pt 2):524-526.
[9]梁鸿彬,郭谦,张新禄,等.血管内超声指导急性冠脉综合征患者冠状动脉非左主干临界病变治疗的临床效果[J].南方医科大学学报,2017,37(5):707-711.
[10]赵磊磊,董平栓,王可,等.血管内超声在ST段抬高型心肌梗死临界病变急诊介入治疗中的应用[J].中国医学影像学杂志,2016,7(12):519-523.
[11]马春燕,李楠,刘爽,等.二维斑点追踪检测心肌跨壁应变梯度在非ST段抬高型心肌梗死中的应用[J].中国医学影像技术,2013,2(29):217-220.
[12]Basra SS,Virani SS,Paniagua D,et al.Acute coronary syndromes:unstable angina and non-ST elevation myocardial infarction[J].Cardiol Clin,2014,32(3):353-370.
[13]朱红涛,邱林林,李斌义,等.冠状动脉急性完全闭塞的不典型心电图分析[J].临床心血管病杂志,2017,33(9):870-874.