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題名 | Regional Myocardial Contractile Function Change Evaluated by Tissue Doppler Imaging after Primary Angioplasty=應用組織都卜勒超音波評估緊急血管整形術後心肌局部收縮功能之變化 |
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作 者 | 王禎煜; 莊文博; 高憲立; 林隆君; 吳造中; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 23:2 2007.06[民96.06] |
頁次 | 頁89-96 |
分類號 | 415.3161 |
關鍵詞 | 急性心肌梗塞; 緊急血管整形術; Strain與strain rate影像; Acute myocardial infarction; Primary angioplasty; Strain and strain rate imaging; |
語文 | 英文(English) |
中文摘要 | 背景 利用組織都卜勒超音波量測心肌的strain與strain rate,可以做為準確評估局部心肌收縮功能的方法。然而,在急性心肌梗塞經緊急血管整形術後,心肌梗塞的區域與鄰近的心肌問,互相有牽扯的效應,這些指標的連續變化並未被研究過。 方法 在16位接受緊急血管整形術的ST段上升之急性心肌梗塞病人,於緊急血管整形術後立即進行心臟超音波檢查,並於24小時、72小時後追蹤,量測peak systolic strain rate (S(下標 SR)、postsystolic shortening (PSS)、peak strain rate in early diastole (E(下標 SR))、late diastole(A(下標 SR)和peak systolic Strain(ε(下標 sys))。在6個月之後,安排心臟超音波或鉈-201掃描來判定心肌梗塞部位的組織存活性。 結果 於緊急血管整形術後,心肌梗塞區域的S(下標 SR)與鄰近心肌比較,有顯著的降低(P<0.05),同時PSS的產生也具有意義的差別(P<0.05)。更深入分析,S(下標 SR)的降低與PSS的產生僅在第一組病人觀察到,並未發生於第二組病人。在第一組病人,心肌梗塞區域的PSS在72小時後恢復(P<0.05 versus血管整形術後24小時),與鄰近心肌的PSS比較,已無顯著差異,而心肌梗塞區域的S(下標 SR)仍有顯著的降低(P<0.05)。 結論 使用strain與strain rate影像,可準確量測心肌梗塞區域,越多的心肌損傷,造成越多的strain rate變化。急性心肌梗塞後進行的再塑形過程,特別香生在心肌壞死的梗塞區域,可以利用strain rate影像來評估。PSS恢復的連續變化,無法作為評估心肌存活性的替代參數。 |
英文摘要 | Background: Myocardial strain and strain rate measurement derived by tissue Doppler imaging has been shown to be a sensitive method to quantify regional myocardial contractile function. However, the sequential changes of these parameters in the infarct area and remote zones, which may have tethering effect, after successful primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) have not been demonstrated. Methods: Sixteen patients with acute ST-elevation myocardial infarction who underwent successful PCI were included in this study. We performed echocardiography soon, 24 hours and 72 hours after primary PCI, to measure the peak systolic strain rate (S(subscript SR)), postsystolic shortening (PSS), peak strain rate in early diastole (E(subscript SR)), late diastole (A(subscript SR)) and peak systolic strain (e) to characterize the myocardial contraction. Follow-up echocardiography or thallium-201 myocardial perfusion imaging were performed 6 months later to identify patients who showed persistent akinesia or fixed perfusion defect as group 1. Those patients who had imaging examinations implicating viable myocardium were classified as group 2. Results: Soon after primary PCI, 5SR was significantly lower in the infarct zones than in remote zones (P<0.05), with concurrent development of PSS (P<0.05). Furthermore, the reduction of SSR and development of PSS were observed in group 1, not in group 2. However, the PSS of infarct zones in group 1 recovered after 72 hours (P<0.05 versus 24 hours after PCI) and reached no significant difference in comparison with that of remote zones when the SSR of the infarct zones remained significantly lower (P<0.05). Conclusion: The infarct zones can be precisely detected using strain and strain rate imaging. The more myocardium that has vanished, the more the systolic strain rate changes in the infarct zones. Remodeling process after AMI proceeds and can be observed with strain rate imaging, especially in infarct zones with prominent scar formation. However, the sequential PSS recovery could not serve as a surrogate marker of myocardial viability. |
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