RT3D-TTE评价AMI伴中度二尖瓣反流患者PCI术前后二尖瓣构型变化

李晓青; 李林泽; 高磊; 杜欣帅; 李静; 耿戟; 姚文双

doi:10.12125/j.chj.202009050

RT3D-TTE评价AMI伴中度二尖瓣反流患者PCI术前后二尖瓣构型变化

Real-time three-dimensional echocardiography evaluation of mitral valve configuration in patients with acute myocardial infarction and moderate mitral regurgitation before and after PCI

摘要

摘要:
目的通过经胸实时三维超声心动图(RT3D-TTE)评价急性心肌梗死（AMI）伴中度二尖瓣反流患者经皮冠状动脉介入治疗(PCI)术前后二尖瓣构型变化，预测PCI术后患者二尖瓣返流改善情况。
方法选取保定市第一中心医院AMI伴中度二尖瓣反流患者行PCI术治疗患者90例，均接受RT3D-TTE检查。根据术后3个月患者的二尖瓣反流改善情况将其分为未改善组（n=37）和改善组（n=53），采集两组的二尖瓣参数变化，比较治疗前后二尖瓣反流的改善效果。采用logistic回归法筛查影响PCI术后反流未改善情况的相关参数，预测改善效能。
结果未改善组术后的瓣环高度(AH)、幕状区容积(TV)、瓣环三维面积(AA_3D)、瓣环联合处直径(CD)、瓣环周长(AC)和瓣环前外侧至后内侧直径(AL-PM)与本组术前比较差异无统计学意义，瓣环前后直径(AP)低于本组术前（P<0.05）；改善组术后的AH高于本组术前，TV、AA_3D、CD、AC、AL-PM和AP低于本组术前（P<0.05）。术前改善组的AA_3D、CD、AC、AL-PM和AP低于未改善组（P<0.05），术后改善组的TV、AA_3D、CD、AC、AL-PM和AP低于未改善组，AH高于未改善组（P<0.05）。多因素分析结果为：CD、AC、AL-PM、AP与PCI术后反流未改善情况关联密切（ P <0.05）；二尖瓣参数评价PCI术后反流未改善的灵敏度、特异度和准确性的结果分别如下，CD：76%、64%、69%；AC：78%、64%、70%；AL-PM：78%、74%、76%；AP：84%、83%、83%。
结论应用RT3D-TTE检查能够掌握AMI伴中度二尖瓣反流患者的二尖瓣构型特征，预测PCI术后患者二尖瓣反流改善情况。

Abstract:
AIM To evaluate the changes of mitral valve configuration in AMI patients with moderate mitral regurgitation before and after percutaneous coronary intervention (PCI) by real-time three-dimensional echocardiography (RT3D-TTE), and to predict the improvement of mitral regurgitation after PCI.
METHODS 90 patients with acute myocardial infarction and moderate mitral regurgitation who underwent PCI in Baoding first central hospital were selected. According to the improvement of mitral regurgitation 3 months after operation, the patients were divided into two groups: no improvement group (n=37) and improvement group (n=53). Logistic regression method was used to screen the related parameters that affect the situation of no improvement of reflux after PCI, and to predict the improvement efficiency.
RESULTS The following indexes were detected: height of annulus (AH), volume of tentorial area (TV), three-dimensional area of annulus (AA_3D), diameter of annulus junction (CD), circumference of annulus (AC), anterolateral to posteromedial diameter of annulus (AL-PM), anterolateral and anterolateral diameter of annulus (AP). There was no significant difference in AH, TV, AA_3D, CD, AC, AL-PM between the two groups, AP was lower than that before operation (P< 0.05); ah in the improved group was higher than that before operation, TV, AA_3D, CD, AC, AL-PM and AP were lower than those before operation (P < 0.05); AA_3D, CD, AC, AL-PM and AP in the improved group were lower than those in the non improved group (P < 0.05), TV, AA_3D, CD, AC, AL-PM and AP in the improved group were lower than those in the non improved group (P < 0.05) The results of multivariate analysis showed that CD, AC, AL-PM and AP were closely related to the unrewarded reflux after PCI (P < 0.05); the sensitivity, specificity and accuracy of mitral valve parameters in evaluating unrewarded reflux after PCI were as follows: CD: 76%, 64% and 69%; AC: 78%, 64% and 70%; AL-PM: 78%、74% and 76%; AP: 84%、83% and 83%.
CONCLUSION RT3D-TTE examination can grasp the characteristics of mitral valve configuration in patients with acute myocardial infarction and moderate mitral regurgitation, and predict the improvement of mitral regurgitation after PCI.

HTML全文

参考文献(19)

施引文献

资源附件(0)