| 摘要: |
| 【目的】探讨腺苷负荷超声心动图（ASE）联合心肌做功（MW）参数对经皮冠状动脉介入治疗（PCI）后支架内再狭窄患者不同狭窄程度心肌节段收缩功能的评价。【方法】选取我院PCI术后再狭窄患者41例，以冠状动脉造影（CAG）结果为金标准，采用左心室18节段模型，排除腺苷负荷前后图像不满意的12个节段，将获得的726个心肌节段分为无明显狭窄组（狭窄程度＜50％）、中度狭窄组（50％≤狭窄程度≤75％）和重度狭窄组（狭窄程度＞75％）。对比评估腺苷负荷前后不同狭窄程度心肌节段的纵向应变（LS）及心肌有用功（CMW）、无用功（WW）、MW指数（MWI）及MW率（MWE）的变化规律；绘制受试者工作特征（ROC）曲线分析腺苷负荷前后各参数评估PCI术后冠状动脉重度狭窄的效能。【结果】冠状动脉不同程度狭窄组超声应变和心肌做功参数比较差异有统计学意义（P<0.01），且负荷状态下，除了WW，冠状动脉狭窄程度越严重，对应心肌节段MW参数值越小(P<0.01)；冠状动脉非重度狭窄组LS、MWI、MWE、CMW较基础状态下增加，WW较基础状态下减低（P<0.05）；冠状动脉重度狭窄组LS、MWI、MWE、CMW较基础状态下减低，WW较基础状态下增加（P<0.05）。负荷MWI、MWE、CMW的ROC曲线下面积(AUC)较基础状态下增加，负荷CMW预测PCI术后冠状动脉重度狭窄的AUC为0.841，高于负荷MWI、MWE、WW(分别为0.829、0.766、0.685)，其截断值＜1583mmHg%，灵敏度为79％，特异度为75％。【结论】腺苷负荷超声心动图结合心肌做功参数可有效评估PCI术后再狭窄患者不同狭窄程度心肌节段收缩功能，在临床诊疗评价中有良好的应用价值。 |
| 关键词: 腺苷负荷超声心动图 心肌做功 经皮冠状动脉介入治疗 支架内再狭窄 |
| DOI： |
| 投稿时间：2023-11-02修订日期：2024-01-15 |
| 基金项目:实时经胸三维超声二尖瓣定量评估联合多模态技术对滇黔桂地区正常人心脏结构和功能的多中心研究（202102AA310003-22），昆明市卫生健康委员会卫生科研课题项目( NO.2022-09-02-001) |
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| Adenosine load combined with myocardial work to evaluate myocardial segment systolic function in restenosis after PCI |
| Da Wenhui,Ding Yunchuan,Wang Qinghui,Zhao Li,Xu Pengli,Li Jingchi |
| (Department of Ultrasound Medicine,Yan''an Hospital Affiliated to Kunming Medical University,Kunming) |
| Abstract: |
| Abstract: [Objective] To evaluate the parameters of adenosine loading echocardiography (ASE) combined with myocardial work (MW) to evaluate the systolic function of myocardial segment in patients with different degrees of stenosis in in-stent restenosis after percutaneous coronary intervention (PCI).[Methods] In 41 patients with restenosis after PCI in our hospital, using coronary angiography results, the model of 18 segments excluding the adenosine load, 726 myocardial segments were divided into no significant stenosis (stenosis degree <50%), moderate stenosis (55% 75%) and severe stenosis (stenosis> 75%). The longitudinal strain (LS), myocardial useful work (CMMW), useless work (WW), MW index (MWI), and MW rate (MWE) of myocardial segments before and after adenosine load; draw the receiver operating characteristic (ROC) curve to analyze the parameters before and after adenosine load to evaluate the efficacy of severe coronary artery stenosis after PCI.[Results] Statistical differences between ultrasound strain and myocardial work parameters in different degrees of coronary stenosis (P <0.01), in the load state, except for WW, the more severe the coronary artery stenosis is, the smaller the MW parameter value of the corresponding myocardial segment is (P<0.01); LS, MWI, MWE, and CMW increased in non-severe coronary stenosis group compared with basal state, while WW decreased compared with basal state (P <0.05); LS, MWI, MWE, and CMW decreased in severe coronary stenosis, and WW increased compared to basal (P <0.05). The ROC area under the curve (AUC) of load MWI, MWE and CMW increased compared with the base state. The AUC of severe coronary artery stenosis after PCI was 0.841, which was higher than load MWI, MWE and WW (0.829,0.766 and 0.685, respectively), with a cut-off value <1583mmHg%, sensitivity was 79% and specificity was 75%.[Conclusion] Adenosine load echocardiography combined with myocardial work parameters can effectively evaluate the systolic function of myocardial segments in patients with different stenosis degrees in restenosis after PCI, which has good application value in clinical diagnosis and treatment evaluation. |
| Key words: adenosine loading echocardiography myocardial work percutaneous coronary intervention in-stent restenosis |
