摘要
目的：探讨脉冲多普勒组织成像技术(PW-DTI)用于评价冠心病(CAD)患者经皮腔内冠状动脉内介入术(PCI)疗效的价值；研究二尖瓣环平均峰值速度Sa、二尖瓣舒张早期的血流峰值速度(E)与二尖瓣环舒张早期峰值速度(Ea)的比值(E／Ea)是否可以成为评价CAD左心功能较敏感的指标。定量分析PCI术对CAD左室整体舒缩功能及左室重构的影响。方法：52例冠心病患者和20例拟诊冠心病患者(已行冠脉造影检查排除CAD)，分为冠心病组和正常对照组，分析两组间E／Ea的情况。冠心病组患者分为PCI组33人和未行PCI组19人，PCI组于PCI术前5日及术后5日、3月、6月随访，非PCI组于冠脉造影术后2日及术后6月随访；均行PW-DTI及常规超声检查，观察PCI术对左室舒缩功能及重构的影响。其中PCI组据射血分数(EF)分成两个亚组(EF≥50％亚组和30％＜EF＜50％亚组)；亚组间进行术前、术后比较；分别分析PCI术对亚组左室功能的影响。结果：(1)CAD患者E／Ea较健康人高，P＜0.01。(2)E／Ea与Ea有较高的相关性，(术前及术后6月r=-0.697，-0.720，P＜0.0001)。(3)6月后，PCI组平均Sa明显增高，E／Ea显著降低，P＜0.001。(4)PCI术前30％＜EF＜50％的患者左室收缩功能改善更明显。(5)6月后，未行PCI术的CAD患者LVESVI、LVEDVI显著增高，P＜0.05。(6)E／Ea与平均Sa存在相关性，(术前及术后6月r=-0.607，-0.705，P＜0.001)。结论：(1)Sa可作为评价冠心病左室收缩功能的较敏感指标。(2)E／Ea可作为评价冠心病左室舒张功能的敏感指标。(3)PCI可改善冠心病患者左室舒缩功能，延缓左室重构的发生。(4)PCI对术前即存在收缩功能不全的冠心病患者改善作用更明显。(5)PW-DTI可作为冠心病PCI疗效的评价方法。
OBJECTIVE: To investigate left ventricular systolic and diastolic function and left ventricular remodeling by mitral annulus motion velocity with pulsed-wave Doppler Tissue Imaging
(PW-DTl) in patients with coronary arteriosclerosis disease(CAD) after percutaneous coronary intervention (PCI), mainly included percutaneous transluminal coronary angioplasty(PTCA) and stent, and evaluate Sa and E/Ea as a sensitive index of CAD patients cardiac function used in clinic. METHODS: we research 52 patients with CAD and 20 health volunteers, who were diagnosed by coronary artery angiography . E/Ea were compared in two groups .All of patients in CAD were divided into two groups, PCI group (n=33) and non-PCI group(n=19), who were treated with normal drug management and performed in examination by PW-DTI and conventional echocardiography in the follow-up period pre-intervention and the 5th day, the 3rd month and 6th month post-intervention in PCI ones, pre-angiography and 6th month post-angiography in non-PCI ones, to research PCI effect on left ventricular function and remodeling in patients with CAD, Then, in PCI group, the patients were divided two subgroups
(subgroups: EF>50% and 30% < EF < 50%) as ejection fraction (EF) to analysis the difference of left ventricular function and remodeling pre- and post-intervention in different subgroups. RESULTS: (1) E/Ea inCAD patients significantly elevated compared with health volunteers (P < 0.01).(2) there was a strong correlation between E/Ea and Ea (pre- and post-intervention r=-0.697,-0.720,P < 0.0001).(3) There were significantly elevated in Sa and decreased in E/Ea in patients of PCI group(P < 0.05). (4) The patients of 30% < EF < 50% pre-intervention changed better than that of ones EF>0%. (5) The left ventricular end-systolic volume index (LVESVI) and left ventricular end-diastolic volume index (LVEDVI) in non-PCI group were significantly elevated in the 6th month post-angiography(P < 0.05). (6) E/Ea correlated with Sa (pre- and
post-intervention r=-0.607,-0.705,P < 0.001). CONCLUSIONS: (1) Sa could be a clinic sensitive value to evaluate left ventricular systolic function of CAD patients.(2) E/Ea could be a clinic sensitive value to evaluate left ventricular diastolic function of CAD patients. (3) PCI could be a useful way to promot to cardiac systolic and diastolic function of CAD patients and to delay left ventricular remodeling. (4) The effects of PCI are more distinct on the CAD patients of pre-intervention dysfunction. (5) PW-DTI is a useful and optional tool to follow-up effect of PCI on patients with CAD.
引文
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