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目的:应用二维斑点追踪成像(2D-STE)技术检测非ST段抬高型心肌梗死(NSTEMI)患者左室心肌分层应变,探讨其在诊断NSTEMI中的临床价值。方法:60例急性心肌梗死(AMI)患者,根据心电图分为NSTEMI组(30例)、ST段抬高型心肌梗死(STEMI)组(30例),匹配对照组(30例),分别获取心尖四腔观、两腔观、心尖长轴观及二尖瓣、乳头肌、心尖水平左室短轴清晰二维图像,EchoPac软件获取左室三层心肌的整体收缩峰值纵向应变(GLS)及环向应变(GCS)、节段收缩峰值纵向应变(TLS)和环向应变(TCS),并计算跨壁梯度#GLS、#GCS、#TLS、#TCS。结果:1根据选择性冠脉造影(SCA)结果将NSTEMI组和STEMI组患者左室节段分为正常节段和受累节段;2与对照组比较,NSTEMI组、STEMI组左室三层心肌GLS、#GLS及受累节段TLS、#TLS均减低(P<0.05);与NSTEMI组比较,STEMI组左室三层心肌GLS、#GLS及受累节段TLS、#TLS无统计学差异;3与对照组比较,NSTEMI组、STEMI组左室三层心肌GCS、#GCS及受累节段TCS、#TCS均减低(P<0.05);与NSTEMI组比较,STEMI组仅心外膜下心肌GCS减低(P<0.05),余应变指标无统计学差异。结论:2D-STE技术左室心肌分层应变参数能准确评价心肌梗死患者左室各层心肌纵向及环向运动,为临床识别NSTEMI提供有价值信息。
Objective: To investigate the stratified strain of left ventricular myocardium in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by 2D-STE and explore its clinical value in the diagnosis of NSTEMI. Methods: Sixty patients with acute myocardial infarction (AMI) were divided into NSTEMI group (30 cases), STEMI group (30 cases) and matched control group (30 cases) according to electrocardiogram Four-chamber view, two-chamber view, apical long axis views and mitral, papillary muscles, apical horizontal left ventricular short axis clear two-dimensional images, EchoPac software to obtain left ventricular three-dimensional myocardial systolic peak longitudinal strain (GLS) The strain (GCS), segmental contraction peak longitudinal strain (TLS) and circumferential strain (TCS) were calculated and transmural gradients # GLS, # GCS, # TLS and # TCS were calculated. According to the results of selective coronary angiography (SCA), the left ventricular segment was divided into normal segments and affected segments in NSTEMI group and STEMI group.2 Compared with the control group, left ventricular three-layer myocardium in NSTEMI group and STEMI group GLS, # GLS, and TLS and # TLS in affected segments decreased (P <0.05). Compared with NSTEMI group, there was no significant difference in GLS, # GLS, TLS and # TLS of affected segments in STEMI group; 3 Compared with the control group, GCS, # GCS and TCS, # TCS of affected segments in the NSTEMI group and the STEMI group decreased (P <0.05). Compared with the NSTEMI group, only the subepicardial GCS decreased in the STEMI group (P <0.05), the residual strain index had no statistical difference. Conclusion: 2D-STE LV stratified strain parameters can accurately evaluate the longitudinal and circumferential movement of left ventricular myocardium in patients with myocardial infarction, and provide valuable information for the clinical identification of NSTEMI.