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背景:局部心肌舒张功能异常是心肌缺血、梗死的早期和特征性表现。应变率成像是一种新型超声成像技术,具有良好的时间和空间分辨率,可用于定量分析局部心肌功能。目的:应用应变率成像技术定量分析并比较心绞痛与心肌梗死患者左室缺血及梗死心肌舒张期应变率变化,探讨其评价冠状动脉粥样硬化性心脏病(简称冠心病)患者左室局部舒张功能异常的价值。设计:病例对照研究。单位:中山大学附属第二医院心血管内科。对象:选取2005-10/2006-04中山大学附属第二医院门诊和住院患者作为研究对象,其中冠心病心绞痛组11例、心肌梗死组21例,对照组20例。方法:常规超声检查后,取心尖四腔、二腔及左室长轴观,应用二维彩色组织多普勒速度模式记录左室侧壁、后间隔、下壁、前壁、后壁及前间隔的运动图像,并存入磁光盘。利用QLAB4.2分析软件进行脱机分析,获取SR曲线。主要观察指标:分析心绞痛组缺血心肌、心肌梗死组梗死心肌和对照组左室心肌节段。分别测量舒张早期峰值应变率(SRe)和舒张晚期峰值应变率(SRa)。结果:缺血、梗死心肌的SRe和SRa均显著低于正常心肌(P<0.05);梗死心肌与缺血心肌相比,SRe及SRa均无显著性差异(P>0.05)。结论:应变率成像测得SRe和SRa可反映冠心病患者左室局部心肌舒张功能异常,但对于缺血与梗死心肌的鉴别诊断价值有限。
BACKGROUND: Local myocardial diastolic dysfunction is an early and characteristic manifestation of myocardial ischemia and infarction. Strain rate imaging is a new ultrasound imaging technique with good temporal and spatial resolution for quantitative analysis of local myocardial function. OBJECTIVE: To quantitatively analyze and compare the changes of left ventricular ischemia and myocardial diastolic strain rate in patients with angina pectoris and myocardial infarction by means of strain rate imaging and to evaluate the changes of left ventricular diastolic function in patients with coronary atherosclerotic heart disease (referred to as coronary heart disease) Abnormal value of the function. Design: Case-control study. Unit: Department of Cardiology, Second Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS: Outpatients and inpatients from the Second Affiliated Hospital of Sun Yat-sen University from October 2005 to April 2006 were selected as subjects, including 11 patients with coronary heart disease angina pectoris group, 21 patients with myocardial infarction group and 20 patients with control group. Methods: After routine ultrasound examination, taking the apical four-chamber, two-chamber and left ventricular long axis views, the left ventricular lateral wall, posterior septum, inferior wall, anterior wall, posterior wall and anterior Interval motion images, and save it to a magneto-optical disc. Use QLAB4.2 analysis software for offline analysis to obtain SR curve. MAIN OUTCOME MEASURES: Left ventricular myocardial segments of ischemic myocardium, myocardial infarction group and control group were analyzed. The peak early diastolic strain (SRe) and late diastolic peak strain (SRa) were measured. Results: SRe and SRa in ischemic and infarcted myocardium were significantly lower than those in normal myocardium (P <0.05). There were no significant differences in SRe and SRa between ischemic myocardium and ischemic myocardium (P> 0.05). Conclusion: SRe and SRa measured by strain rate imaging can reflect the local left ventricular diastolic dysfunction in patients with coronary heart disease. However, the differential diagnosis of ischemic and infarcted myocardium is limited.