應用超聲三維斑點追蹤技術評價非ST段抬高型急性冠脈綜合征患者心功能變化的研究
發(fā)布時間：2019-05-29 03:44
【摘要】：目的:應用超聲三維斑點追蹤技術(3D-STI)對非ST段抬高型急性冠脈綜合征(NSTE-ACS)患者PCI術前與術后及非冠心病患者進行心功能指標比較,并與其冠脈造影結果進行相關性分析。研究該技術在評價PCI術對NSTE-ACS患者心功能變化的臨床應用價值。方法:納入在我院住院行經(jīng)皮冠脈造影(CAG)檢查排除冠心病診斷的患者62例作為對照組,入選同期入院診斷為NSTE-ACS患者137例為觀察組,其中急性非ST段抬高型心肌梗死(NSTEMI)患者57例,不穩(wěn)定性心絞痛(UAP)患者80例。對納入對象均行常規(guī)心臟彩超和3D-STI檢查,獲取左室整體縱向應變(LVGLS)、圓周應變(LVGCS)、徑向應變(LVGRS)、左心室舒張末期容積(LVEDV)、左心室收縮末期容積(LVESV)、左心室射血分數(shù)(LVEF),同時獲取常規(guī)超聲參數(shù)左室收縮末徑(LVESD)、左室舒張末內(nèi)徑(LVEDD)、室間隔厚度(IVST)、左室后壁厚度(LVPWT),E/A值。所有患者均行CAG檢查,NSTE-ACS患者行經(jīng)皮冠脈介入(PCI)治療。搜集所有患者的一般臨床資料(主要包括BMI、吸煙史、高血壓病史、糖尿病病史、冠心病家族史)及血化驗指標N-末端B型腦鈉肽(NT-pro BNP)、肌鈣蛋白T(c TNT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏C反應蛋白(hs-CRP)等。對PCI術后患者進行隨訪3~6個月,觀察患者血化驗指標及超聲指標的變化,記錄患者發(fā)生的MACE事件。對3D-STI超聲心動參數(shù)及血清學結果進行分析,對兩組間參數(shù)比較采用Dunnett-t檢驗,多組間參數(shù)相比利用單因素方差分析法,3D-STI超聲心動參數(shù)與左室射血分數(shù)進行Pearson相關性分析,觀察組術前、術后各項指標比較采用配對樣本t檢驗。結果:1.常規(guī)超聲參數(shù)LVESD?LVEDD?IVST?LVPWT在NSTEMI組較UAP組及對照組均明顯增大,LVEF明顯降低,差異均有統(tǒng)計學意義(P0.05),而在UAP組及對照組之間比較無明顯改變。E/A在三組間比較,僅在NSTEMI組較對照組明顯減低,差異有統(tǒng)計學意義(P0.05)。3D-STI超聲心動檢查顯示在NSTEMI組患者中LVGLS?LVGCS?LVEF較對照組和UAP組均明顯減低,僅LVGRS較對照組明顯減低(P0.05),而LVESV較對照組及UAP組均明顯增加(P0.05)。在UAP組患者中LVGLS?LVGCS?LVGRS較對照組明顯減低(P0.05),而LVEF?LVESV?LVEDV較對照組比較無明顯變化(P0.05)。2.LVGLS?LVGCS?LVESV?NT-pro BNP?hs-CRP?c Tn T與LVEF呈負相關,且LVGLS與LVEF相關性較顯著,而LVGRS?LVEDV與LVEF未發(fā)現(xiàn)有明顯相關性(P0.05)。3.LVGLS?LVGCS?LVEF在雙支病變和三支病變組中較單支病變組明顯減低(P0.05),并且LVGLS?LVEF在三支病變組中較雙支病變組也明顯減低(P0.05)。LVGRS僅在三支病變組中較單支病變組明顯減低(P0.05),在其他組間比較未見明顯變化(P0.05)。LVESV在三支病變和雙支病變組較單支病變組均明顯增大,差異有統(tǒng)計學意義(P0.05)。4.LVGLS?LVGCS?LVGRS?LVEF在UAP組、NSTEMI組中術后均明顯增加,而LVESV?LVEDV術后則明顯減小(P0.05)。LVGLS?LVGCS?LVEF在單支病變組、雙支病變組、三支病變組中術后均明顯增加,LVGRS在三支病變組及雙支病變組術后明顯增加(P0.05)。LVESV?LVEDV在雙支病變組及三支病變組術后均明顯減小(P0.05),而在單支病變組術后無明顯變化(P0.05)。結論:1.3D-STI超聲心動技術較常規(guī)心臟彩超,能夠更客觀、有效、全面、定量的反映NSTE-ACS患者左室心功能狀況,具有一定的臨床應用價值。2.PCI術可以明顯改善NSTE-ACS患者心功能狀況并改善預后,3D-STI超聲技術可以有效的評價PCI療效。3.3D-STI超聲心動參數(shù)LVGLS?LVGRS?LVGCS在NSTE-ACS患者中PCI術后均有改善。其中LVGLS較其他參數(shù)對評價心功能變化的敏感性更高。4.3D-STI超聲技術可以很好的評價冠狀動脈缺血程度。
[Abstract]:Objective: To compare the cardiac function of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by ultrasonic three-dimensional spot-tracking (3D-STI). To evaluate the clinical value of the technique in evaluating the cardiac function of NSTE-ACS patients. Methods:62 cases of patients with coronary heart disease (CHD) were treated with coronary angiography (CAG) in our hospital, and in the control group,137 patients with NSTE-ACS were enrolled in the same period, and the patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) were enrolled in 57 cases. 80 patients with unstable angina pectoris (UAP). Left ventricular integral longitudinal strain (LVGLS), circumferential strain (LVGCS), radial strain (LVGRS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), At the same time, the left ventricular systolic end diameter (LVESD), the left ventricular end-diastolic diameter (LVEDD), the ventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT), and the E/ A value were obtained. All patients underwent CAG and NSTE-ACS was treated with percutaneous coronary intervention (PCI). The general clinical data of all patients (including BMI, smoking history, history of hypertension, history of diabetes, family history of coronary heart disease) and blood test index N-terminal B-type brain natriuretic peptide (NT-pro BNP), troponin T (c-TNT), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) were collected. Hypersensitive C-reactive protein (hs-CRP), etc. The patients with PCI were followed up for 3 to 6 months, and the changes of the blood test index and the ultrasonic index of the patients were observed, and the MACE events occurred in the patients were recorded. The 3-D-STI echocardiographic parameters and the serological results were analyzed. Dunnett-t test was used to compare the parameters between the two groups. The correlation between the three-group parameters and the left ventricular ejection fraction was analyzed by using one-factor analysis of variance method, 3D-STI echocardiography and left ventricular ejection fraction. The post-operative indexes were compared with the paired t-test. Results:1. The LVESD? LVEDD? IVST? LVPWT in the NSTEMI group was significantly higher in the NSTEMI group than in the UAP group and the control group (P0.05), and there was no significant change between the UAP group and the control group. The results showed that the LVGLS-LVGCS-LVEF in the patients with NSTEMI was significantly lower in the NSTEMI group than in the control group (P0.05). Compared with the control group and UAP group, the LVESV was significantly increased (P0.05). LVGLS-LVGCS-LVGRS in the patients with UAP group was significantly lower than that in the control group (P0.05). LVEF-LVESV? LVESV? NT-pro BNP? hs-CRP? c Tn T was negatively correlated with LVEF, and the correlation between LVGLS and LVEF was significant. The LVGRS-LVEDV had no significant correlation with LVEF (P0.05). There was no significant change between the other groups (P0.05). The LVESV was significantly increased in the three-vessel and double-branch lesion groups, and the difference was significant (P0.05). The results showed that LVGRS increased significantly after operation (P <0.05). LVESV? LVEDV decreased significantly after operation (P0.05). Conclusion: 1.3 D-STI echocardiography is a more objective, effective, comprehensive and quantitative analysis of left ventricular function in patients with NSTE-ACS. The 3D-STI ultrasound technique can be used to evaluate the curative effect of the PCI. The LVGLS-LVGRS-LVGCS of the 3D-STI echocardiography is improved after PCI in the patients with NSTE-ACS. The sensitivity of LVGLS to the change of heart function was higher than that of other parameters.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
本文編號：2487614
[Abstract]:Objective: To compare the cardiac function of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by ultrasonic three-dimensional spot-tracking (3D-STI). To evaluate the clinical value of the technique in evaluating the cardiac function of NSTE-ACS patients. Methods:62 cases of patients with coronary heart disease (CHD) were treated with coronary angiography (CAG) in our hospital, and in the control group,137 patients with NSTE-ACS were enrolled in the same period, and the patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) were enrolled in 57 cases. 80 patients with unstable angina pectoris (UAP). Left ventricular integral longitudinal strain (LVGLS), circumferential strain (LVGCS), radial strain (LVGRS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), At the same time, the left ventricular systolic end diameter (LVESD), the left ventricular end-diastolic diameter (LVEDD), the ventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT), and the E/ A value were obtained. All patients underwent CAG and NSTE-ACS was treated with percutaneous coronary intervention (PCI). The general clinical data of all patients (including BMI, smoking history, history of hypertension, history of diabetes, family history of coronary heart disease) and blood test index N-terminal B-type brain natriuretic peptide (NT-pro BNP), troponin T (c-TNT), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) were collected. Hypersensitive C-reactive protein (hs-CRP), etc. The patients with PCI were followed up for 3 to 6 months, and the changes of the blood test index and the ultrasonic index of the patients were observed, and the MACE events occurred in the patients were recorded. The 3-D-STI echocardiographic parameters and the serological results were analyzed. Dunnett-t test was used to compare the parameters between the two groups. The correlation between the three-group parameters and the left ventricular ejection fraction was analyzed by using one-factor analysis of variance method, 3D-STI echocardiography and left ventricular ejection fraction. The post-operative indexes were compared with the paired t-test. Results:1. The LVESD? LVEDD? IVST? LVPWT in the NSTEMI group was significantly higher in the NSTEMI group than in the UAP group and the control group (P0.05), and there was no significant change between the UAP group and the control group. The results showed that the LVGLS-LVGCS-LVEF in the patients with NSTEMI was significantly lower in the NSTEMI group than in the control group (P0.05). Compared with the control group and UAP group, the LVESV was significantly increased (P0.05). LVGLS-LVGCS-LVGRS in the patients with UAP group was significantly lower than that in the control group (P0.05). LVEF-LVESV? LVESV? NT-pro BNP? hs-CRP? c Tn T was negatively correlated with LVEF, and the correlation between LVGLS and LVEF was significant. The LVGRS-LVEDV had no significant correlation with LVEF (P0.05). There was no significant change between the other groups (P0.05). The LVESV was significantly increased in the three-vessel and double-branch lesion groups, and the difference was significant (P0.05). The results showed that LVGRS increased significantly after operation (P <0.05). LVESV? LVEDV decreased significantly after operation (P0.05). Conclusion: 1.3 D-STI echocardiography is a more objective, effective, comprehensive and quantitative analysis of left ventricular function in patients with NSTE-ACS. The 3D-STI ultrasound technique can be used to evaluate the curative effect of the PCI. The LVGLS-LVGRS-LVGCS of the 3D-STI echocardiography is improved after PCI in the patients with NSTE-ACS. The sensitivity of LVGLS to the change of heart function was higher than that of other parameters.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
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