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目的探讨对于不同部位心肌梗死,超声二维斑点追踪技术定量判断局部室壁运动异常及心脏整体收缩功能状态的临床应用价值。方法二维超声记录左室长轴和短轴切面高帧频图像,应用超声二维斑点追踪技术测量左室心肌各节段纵向、径向、圆周应变值。结果与正常对照组对比,前壁心肌梗死组左室16/17节段的纵向应变值、11/18节段的径向应变值、12/18节段的圆周应变值减低,其中前、侧壁、室间隔及心尖部应变值减低较其余节段更为显著(P<0.05);下壁心肌梗死组左室15/17节段的纵向应变值、5/18节段的径向应变值、10/18节段的圆周应变值减低,其中下、后壁应变值减低较其余节段更为显著(P<0.05)。前壁心肌梗死组平均纵向应变、平均圆周应变及平均径向应变值均与左室射血分数(Left ventricular ejection fraction,LVEF)值显著相关(r=-0.74,r=-0.78,P<0.001;r=0.69,P<0.05),下壁心肌梗死组仅平均纵向应变值与LVEF值显著相关(r=-0.82,P<0.05)。结论超声二维斑点追踪技术是准确、定量评价心脏局部室壁运动异常及整体收缩功能新的无创方法。纵向应变值可能是全面、准确、定量评价心功能的指标,而圆周及径向应变值的作用则有待进一步研究。
Objective To investigate the clinical value of determining the abnormality of regional wall motion and the global systolic function in patients with myocardial infarction and two-dimensional speckle tracking by ultrasound. Methods Two-dimensional ultrasonography was used to record high frame rate images of long axis and short axis of left ventricle. The vertical, radial and circumferential strain values of each segment of left ventricular myocardium were measured by two-dimensional speckle tracking. Results Compared with the normal control group, the longitudinal strain, the radial strain in the 11 / 18th segment and the circumferential strain in the 12 / 18th segment in the anterior wall myocardial infarction group were significantly decreased Wall, septal and apex degeneration was more significant than the other segments (P <0.05). In the inferior wall myocardial infarction group, the longitudinal strain values in 15/17 segments, radial strain values in 5/18 segments , While the circumferential strain values of the 10/18 segments decreased. The lower and the posterior wall strain values decreased more significantly than the other segments (P <0.05). Mean longitudinal strain, mean circumferential strain and mean radial strain in the anterior wall myocardial infarction group were significantly correlated with left ventricular ejection fraction (LVEF) (r = -0.74, r = -0.78, P <0.001 ; r = 0.69, P <0.05). Only the average longitudinal strain value in lower wall myocardial infarction group was significantly correlated with LVEF (r = -0.82, P <0.05). Conclusion Ultrasound two-dimensional speckle tracking is a new noninvasive method for accurate and quantitative evaluation of regional wall motion abnormalities and global systolic function. Longitudinal strain value may be a comprehensive, accurate and quantitative evaluation of cardiac function index, and the role of circumferential and radial strain values needs further study.