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目的探讨定量组织速度成像(QTVI)技术在冠心病患者心肌缺血评价中的价值,同时采用QTVI技术观察冠状动脉(冠脉)支架植入术后左室局部心肌功能变化,以评价其疗效。方法 53例临床诊断冠心病或可疑冠心病行冠脉造影检查(CAG)的患者纳入本研究。在行CAG检查前作QTVI检查,根据节段室壁运动速度情况(以心底部5cm/s,中段3cm/s界定)分为无心肌缺血组(n=26)和心肌缺血组(n=27)。测定左室6个壁的基底段和中段运动的收缩期峰流速(Vs)与峰值位移(Ds),比较2组的Vs及Ds,并与CAG结果对照,以评价QTVI对冠心病的诊断价值。其中8例单纯左前降支(LAD)病变患者分别于支架植入前1天、植入后1周、4周采用QTVI技术分析室壁的运动速度指标(Vs),以评价支架植入术的疗效。结果在左室长轴切面、心尖四腔切面、心尖两腔切面心肌缺血组左室相应节段的Vs和Ds均低于无心肌缺血组(P<0.05);QTVI发现的有心肌缺血的27例患者,CAG均能发现2支或以上主要冠脉狭窄;8例LAD病变患者冠脉支架植入术前LAD供血区各节段心肌Vs均明显低于无心肌缺血组(P<0.01或P<0.05),与冠脉支架植入前相比,治疗后1周及4周,LAD供血区各节段心肌Vs明显增快(P<0.01或P<0.05)。结论 QTVI技术通过定量测定节段性室壁运动失调及局域性心功能不良,可以评价冠心病严重冠脉狭窄患者的心肌缺血,且可作为一种测定冠脉支架植入前后局部心肌速度的无创技术,用以评价冠脉支架植入术的疗效。
Objective To investigate the value of quantitative tissue velocity imaging (QTVI) in the evaluation of myocardial ischemia in patients with coronary heart disease. QTVI was used to observe the changes of left ventricular regional myocardial function after coronary artery (coronary) stent implantation to evaluate its curative effect. Methods Fifty-three patients with clinically diagnosed coronary heart disease or suspected coronary artery disease undergoing coronary angiography (CAG) were enrolled in this study. QTVI was performed before the CAG examination. According to the velocity of segment wall movement (defined as 5 cm / s at the bottom of the heart and 3 cm / s at the middle), the patients were divided into two groups: no myocardial ischemia group (n = 26) and myocardial ischemia group (n = 27). The Vs and peak displacement (Ds) of the basal and middle segments of left and right ventricles were measured, and the Vs and Ds of the two groups were compared with those of CAG to evaluate the diagnostic value of QTVI in coronary heart disease . Among them, 8 patients with simple left anterior descending artery (LAD) lesions were evaluated on the wall velocity (Vs) by QTVI technique 1 day before stent implantation and 1 week and 4 weeks after implantation to evaluate the effect of stent implantation Efficacy. Results The Vs and Ds in the left ventricular segment of the left ventricle in the long axis of the left ventricle, the apex quadruple-section, and the apex of the atrium in two-compartment transection were significantly lower than those in the non-ischemic myocardium (P <0.05). Myocardial ischemia In 27 patients with blood, two or more major coronary stenoses were found in CAG. The Vs in all segments of LAD before coronary artery stent implantation in 8 patients with LAD lesion were significantly lower than those without myocardial ischemia <0.01 or P <0.05). Compared with those before coronary stent implantation, the Vs of myocardium in each segment of LAD were significantly increased (P <0.01 or P <0.05) at 1 and 4 weeks after treatment. Conclusions QTVI can be used to assess myocardial ischemia in patients with severe coronary artery stenosis by quantitative determination of segmental wall motion disorders and regional cardiac dysfunction and can be used as a measure of local myocardial velocity before and after coronary stent implantation Noninvasive technique to evaluate the efficacy of coronary stenting.