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目的应用组织多普勒成像技术(TDI)与实时三维超声心动图(RT-3DE)联合评价急诊经皮冠状动脉介入治疗(PCI)及常规药物治疗对老年人(65~75岁)首发急性前壁心肌梗死后左心室重构(LVRM)的影响,评价其临床应用价值。方法对2010年6月—2013年12月于唐山市工人医院确诊为急性前壁心肌梗死的老年人,A组225例患者行急诊PCI治疗;B组150例患者行常规药物治疗,于就诊后即刻(6h内)、PCI术后及常规药物治疗即刻,治疗后2个月及6个月进行超声心动图观察。所测参数有:左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、二尖瓣环舒张早期与舒张晚期运动峰值速度之比(Ea/Aa)、梗死区的局部室壁运动指数(RWMI)。结果 A组结果观察得出,LVEDV、LVESV、RWMI随检测时间延长逐渐降低,术后2个月和6个月较前显著降低;LVEF、Ea/Aa逐渐升高;B组结果观察得出,LVEDV、LVESV、RWMI呈缓慢降低,LVEF、Ea/Aa逐渐升高;6个月后组间比较得出,LVEDV、LVESV、RWMI,A组明显低于B组,LVEF、Ea/Aa,A组明显高于B组。结论 TDI与RT-3DE数据联合能准确测定左心室重构,有助于评价老年AMI患者行急诊PCI后的效果;老年AMI行急诊PCI远期预后优于常规药物治疗,有助于左室收缩和舒张功能的恢复,有效减轻左心室重构。
Objective To evaluate the diagnostic value of Tissue Doppler Imaging (TDI) combined with real-time three-dimensional echocardiography (RT-3DE) in the evaluation of emergency percutaneous coronary intervention (PCI) and routine drug treatment in elderly (65-75 years) Left ventricular remodeling after myocardial infarction (LVRM), evaluate its clinical value. Methods A total of 225 elderly patients with acute anterior myocardial infarction who were diagnosed as acute anterior myocardial infarction in Tangshan Workers’ Hospital from June 2010 to December 2013 were enrolled in this study. All of the 150 patients in group B received routine medical treatment. After treatment, Echocardiography was performed immediately (within 6h), immediately after PCI and after conventional medical therapy, 2 months and 6 months after treatment. The parameters measured were LVEDV, LVESV, LVEF, Ea / Aa ), Regional wall motion index (RWMI) in the infarct zone. Results The results of group A showed that the LVEDV, LVESV and RWMI decreased gradually with the prolongation of test time, decreased significantly at 2 months and 6 months after operation, LVEF and Ea / Aa gradually increased, while in group B, LVEDV, LVESV and RWMI decreased slowly and LVEF and Ea / Aa gradually increased. After 6 months, LVEDV, LVESV and RWMI in group A were significantly lower than those in group B, LVEF, Ea / Aa and A Significantly higher than the B group. Conclusion The combination of TDI and RT-3DE data can accurately determine left ventricular remodeling, which can be used to evaluate the effect of emergency PCI in elderly patients with AMI. The long-term prognosis of elderly patients with AMI is better than routine medication in the treatment of acute left ventricular infarction And the recovery of diastolic function, effectively reduce left ventricular remodeling.