| 摘要: |
| 目的：探讨实时三维超声心动图（RT-3DE）、二维斑点追踪技术（2D-STI）联合血浆游离细胞DNA（cf DNA）评估急性下壁心肌梗死（AIMI）伴右室心肌梗死（RVMI）患者右心房（RA）各时相容积改变及心肌受损情况的临床价值。方法：选择2018年1月-2021年1月于本院初诊为AIMI的98例患者，根据AIMI患者是否合并RVMI可分为AIMI组（50例）和AIMI+RVMI组（48例）；另外选取38例体检健康者作为对照组。术前均行常规二维超声心动图、RT-3DE、2D-STI检查以及血浆cf DNA检测。分析AIMI伴RVMI患者RA的RT-3DE、2D-STI测量指标与RV测量指标、血浆cf DNA水平之间的相关性。评估RT-3DE、2D-STI、血浆cf DNA单独或联合诊断AIMI伴RVMI的诊断效能。结果：AIMI组的常规二维超声心动图、RA的RT-3DE以及2D-STI测量指标与对照组之间的差异均无统计学意义（P>0.05）。而AIMI+RVMI组E/e’、RA的RT-3DE测量指标（RAVmaxI、RAVminI、RAVpreI、TSVI、PSVI以及ASVI）显著高于对照组及AIMI组（P<0.05），而e’、TAPSE、PEF以及RA的2D-STI测量指标（LStot、LSpos）显著低于对照组及AIMI组（P<0.05）。AIMI+RVMI组的血浆cf DNA水平显著高于对照组及AIMI组（P<0.05），而AIMI组的血浆cf DNA水平也显著高于对照组（P<0.05）。AIMI伴RVMI患者RA的RT-3DE测量指标（RAVmaxI、RAVminI、RAVpreI）均与E/e’、血浆cf DNA水平呈正相关（P<0.05），而与TAPSE呈负相关（P<0.05）；AIMI伴RVMI患者RA的2D-STI应变功能测量指标（LStot、LSpos）均与E/e’、血浆cf DNA水平呈负相关（P<0.05），而与TAPSE呈正相关（P<0.05）。RT-3DE、2D-STI联合血浆cf DNA水平诊断AIMI伴RVMI的准确性、敏感度、特异度、阳性预测值、阴性预测值最高（P<0.05）。结论：RT-3DE、2D-STI联合血浆cf DNA水平将有助于提高AIMI伴RVMI的诊断效能，并有利于对AIMI伴RVMI患者RA各时相容积改变及心肌受损情况的评估，进一步为临床治疗方案的选择提供诊断依据。 |
| 关键词: 实时三维超声心动图 二维斑点跟踪成像技术 急性下壁心肌梗死 右室心肌梗死 血浆游离DNA 时相容积 心肌受损 |
| DOI： |
| 投稿时间：2021-05-06修订日期：2021-05-06 |
| 基金项目:江苏省自然科学基金青年科技人才专项资金项目（BK20162363） |
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| Clinical value of real-time three-dimensional echocardiography, two-dimensional speckle tracking imaging technique combined with plasma free cell DNA in evaluating right atrial volume changes and myocardial damage in patients with acute inferior myocardial infarction and right ventricular myocardial infarction |
| Wang Jia-ling |
| () |
| Abstract: |
| Objective: To explore the Clinical value of real-time three-dimensional echocardiography (RT-3DE), two-dimensional speckle tracking imaging technology (2D-STI) combined with plasma free cell DNA (cf DNA) in evaluating right atrial(RA) volume changes and myocardial damage in patients with acute inferior myocardial infarction(AIMI) and right ventricular myocardial infarction(RVMI).Methods: Select 98 patients who were first diagnosed as AIMI in this hospital from January 2018 to January 2021. According to whether AIMI patients are combined with RVMI, they can be divided into AIMI group (50 cases) and AIMI+RVMI group (48 cases); another 38 cases are selected Healthy people on physical examination served as a control group. Routine two-dimensional echocardiography, RT-3DE, 2D-STI and plasma cf DNA testing were performed before surgery. Analyze the correlation between the RT-3DE and 2D-STI measurement indicators of AIMI and RVMI patients with RA, RV measurement indicators, and plasma cf DNA levels. To evaluate the diagnostic efficacy of RT-3DE, 2D-STI, and plasma cf DNA alone or in combination in the diagnosis of AIMI and RVMI.Results:There were no statistically significant differences between the AIMI group""s conventional two-dimensional echocardiography, RA""s RT-3DE and 2D-STI measurement indicators and the control group (P>0.05). The AIMI+RVMI group E/e"", RA RT-3DE measurement indicators (RAVmaxI, RAVminI, RAVpreI, TSVI, PSVI and ASVI) were significantly higher than the control group and AIMI group (P<0.05), while e"", TAPSE, The 2D-STI measurement indexes (LStot, LSpos) of PEF and RA were significantly lower than those of the control group and AIMI group (P<0.05). The plasma cf DNA level of AIMI+RVMI group was significantly higher than that of the control group and AIMI group (P<0.05), and the plasma cf DNA level of AIMI group was also significantly higher than that of the control group (P<0.05). The RT-3DE measurement indexes of RA in AIMI patients with RVMI (RAVmaxI, RAVminI, RAVpreI) were positively correlated with E/e"" and plasma cf DNA levels (P<0.05), but negatively correlated with TAPSE (P<0.05); AIMI The 2D-STI strain function measurement indexes (LStot, LSpos) of RA patients with RVMI were negatively correlated with E/e"" and plasma cf DNA levels (P<0.05), but positively correlated with TAPSE (P<0.05). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RT-3DE, 2D-STI combined with plasma cf DNA levels in the diagnosis of AIMI with RVMI were the highest (P<0.05).Conclusion: The combination of RT-3DE, 2D-STI and plasma cf DNA levels will help improve the diagnostic performance of AIMI with RVMI, and will help evaluate the changes in the volume of RA and myocardial damage in patients with AIMI and RVMI, and further provide clinical treatment The selection of the plan provides a basis for diagnosis. |
| Key words: Real-time three-dimensional echocardiography two-dimensional speckle tracking imaging technology acute inferior myocardial infarction right ventricular myocardial infarction cell-free DNA phase volume myocardial damage |
