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Objective:To evaluate left ventricular systolic function and myocardial perfusion in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by left ventricular pressure-strain loop (PSL).Methods:From August 2020 to December 2020, 47 patients with AMI admitted to the Intensive Care Unit of Cardiovascular Department of the First People′s Hospital of Foshan and treated with PCI were selected. Myocardial contrast echocardiography (MCE) and conventional echocardiography were performed within 72 hours after operation (T1 phase) and conventional echocardiography was repeated 3 months later (T2 phase). Myocardial perfusion scores (MPS) of left ventricular segments were obtained by MCE and the overall myocardial perfusion score index (PSI) was calculated. According to PSI, the patients were divided into good perfusion group and poor perfusion group. Conventional ultrasonic parameters and two-dimensional global longitudinal strain (2D-GLS) were collected. Left ventricular PSL analyzed in off-line EchoPAC software was used to evaluate the left ventricular myocardial work index, including global work index (GWI), global constructive work (GCW), global waste work (GWW), global work efficiency (GWE). The differences of parameters between patients with different perfusion levels and the change of parameters with time at the same perfusion level were compared. ROC curves were used to analyze the diagnostic values of strain parameters and myocardial work parameters in patients with hypoperfusion.Results:There were no significant differences in conventional ultrasound parameters between groups in T1 and T2 phases (all P>0.05), while there were significant differences in 2D-GLS and myocardial work parameters (except GWI in T2 phase) (all P<0.05). The absolute values of 2D-GLS and myocardial work parameters (except GWW ) were higher than those in T1 phase (all P<0.05). There was no significant difference in GWW ( P>0.05), but it decreased in good perfusion group while increased in poor perfusion group over time. ROC curve analysis showed that 2D-GLS, GWI, GCW and GWE had high area under the curve. Conclusions:Left ventricular PSL provides a new sensitive method for the evaluation of cardiac function in patients with AMI after PCI, and is expected to become a new index for the preliminary evaluation of microcirculation.
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BACKGROUND: Despite of restoring epicardial infarct-related artery(IRA) patency after myocardial infarction, microvascular reperfusion were not achieved sometimes, and the deterioration of myocardial perfusion persists in a considerable number of patients. This phenomenon is known as microvascular obstruction (MVO). MVO is often observed in ST-Segment Elevation Myocardial Infarction(STEMI) patients, even if percutaneous coronary intervention (PCI) was successful. In addition, some evidence has indicated that the presence of MVO predicted poor clinical outcomes independent of myocardial infarct size. Noninvasive as well as invasive modes for assessing microvascular perfusion(MVP) are complex, time consuming, and expensive have, there is yet no simple method available at present to assess coronary microcirculation. In this research, we attempt to evaluate the usefulness of left ventricular myocardial work (LVMW), a new index of myocardial performance, for the assessment of MVP in STEMI patients after PCI. METHODS: Forty-seven patients with STEMI treated by PCI were enrolled and underwent a transthoracic doppler echocardiography (TTE) within 24-72 hours after PCI. IRA were left anterior descending (LAD) artery (29,62%), left circumflex (LCX) artery(9,19%), right coronary artery (RCA) (9,19%) respectively. Myocardial contrast echocardiography (MCE) was used to evaluate MVP after PCI, then perfusion score index (PSI) was calculated referring to whether the ultrasonic enhancing agents was replenishment or not. Patients were divided into normal MVP and impaired MVP group according to PSI. Left ventricular global longitudinal strain (GLS) was generated by speckle tracking echocardiography(STE) and pressure-strain loops (PSLs) was used to generate global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). GLS and the MW parameters (GWI, GCW, GWW, GWE) were compared between groups. Receiver operating characteristic (ROC) curves were calculated by plotting sensitivity versus (1-specificity), allowing calculation of the area under the curve (AUC) and the identification of LVMW parameters and GLS cutoff thresholds that best identify STEMI patients with impaired MVP after PCI. RESULTS: In this study, a statistically significant difference was observed in GWI (1163±405 mm Hg% vs 1617±363 mm Hg%), GCW (1296±430 mm Hg% vs 1789±406 mm Hg%), GWE (83±8.52% vs 90±5.58%) and GLS (11.56±3.29 vs 16.65±3.59) between impaired MVP group and normal MVP group. However, there is no statistical significance difference in left ventricular ejection fraction (LVEF), and GWW. ROC analysis revealed that GCW (cut-off value: 1326 mm Hg%, AUC: .80, sensitivity: 95% and specificity: 56%), GWI (cut-off value: 1281 mm Hg%, AUC: .81, sensitivity: 90% and specificity: 70%), GWE (cut-off value: 90%, AUC: .77, sensitivity: 65% and specificity: 78%) and GLS (cut-off value: 12.5, AUC: .86, sensitivity: 90% and specificity: 67%) have appreciable AUC, sensitivity, and specificity to identify STEMI patients with impaired MVP after PCI. CONCLUSION: Measuring LVMW indices of STEMI patients after PCI may add adjuvant value for the assessment of MVP.
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Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Microcirculação , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Purpose To explore the predictive value of myocardial perfusion in assessing myocardial systolic function recovery after primary percutaneous coronary intervention (PPCI),in order to improve poor prognosis by early detection of myocardial no-reflow.Materials and Methods Forty nine patients with acute myocardial infarction (AMI) who had received PPCI were chosen as subjects.All the patients underwent two-dimensional strain (2DS) images and resting real-time myocardial contrast echocardiography (MCE) within one week after surgery,and 2DS measurement was repeated after three months.2DS imaging was used to acquire longitudinal peak systolic strain (LPSS) at all myocardial segments.Based on the graphs of LPSS,left ventricular myocardium was divided into normal contractile function myocardium (red) and impaired contractile function myocardium (light red,blue).According to the myocardial perfusion scores (MPS) qualitatively assessed by MCE visual interpretation,the myocardia with impaired systolic function were categorized into three groups with different perfusion level.The changes of LPSS within one week and three months after surgery (△ LPSS) among the three groups were analyzed.The correlation between MPS and LPSS within one week and three months after PPCI was also analyzed respectively.Results The △ LPSS increased significantly among the three groups with the improvement of myocardial perfusion level [(-5.78±6.23)％ vs.(-4.37±6.60)％ vs.(-1.21 ±4.77)％,all P＜0.05].The MPS measured one week after PPCI was both positively correlated with the LPSS detected within one week after surgery and that after three months (r=0.47,0.58,P＜0.001).The consistence of myocardial perfusion scores given by two evaluators was good (Kappa=0.785,P＜0.05).Conclusion The level of myocardial perfusion after PPCI in patients with AMI is closely related to regional myocardial systolic function,and the improvement of myocardial perfusion can forecast the recovery of regional systolic function.
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Objective To evaluated the value of myocardial perfusion before delayed percutaneous coronary intervention (PCI) for predicting the recovery of systolic function of patients with acute myocardial infarction (AMI).Methods A total of 64 patients with AMI receiving delayed PCI treatment in the First People's Hospital of Foshan from January 2014 to June 2015 were selected.One day prior to delayed PCI,all of the patients underwent two dimensional strain to measure the longitudinal peak systolic strain (LPSS) of each left ventricular segment and the global longitudinal strain (GLS) of the left ventricle.The myocardial perfusion score (MPS) and the perfusion score index (PSI) were measured by myocardial contrast echocardiography (MCE).Left ventricular myocardial perfusions were classified as good,reduced,or absent.The two dimensional strain measurements were again conducted at 6 months after the delayed PCI to assess LPSS and GLS.The change of GLS and LPSS between one day prior to delayed PCI and six months after delayed PCI was assessed by paired t-test.The differences of LPSS among good,reduced,or absent myocardial perfusion groups were analyzed by one-way ANOVA.LSD-t test was used to compare in pairs of groups that had different values.The correlations between PSI and GLS,MPS and LPSS were assessed by Spearman's rank-correlation test.Results The GLS of all patients were higher at six months after delayed PCI than at one day prior to delayed PCI [(-15.39±7.80)％ vs (-12.44±8.38)％,t=14.398,P ＜ 0.001].The LPSS of myocardial perfusion in good,reduced and absent groups at one day prior to delayed PCI were (-2.64±5.60)％,(-6.19±6.87)％ and (-12.07±5.86)％,respectively.The LPSS of myocardial perfusion in good,reduced and absent groups at six months after delayed PCI were (-2.97 ± 4.93)％,(-11.38± 7.26)％ and (-15.82 ± 5.97)％,respectively.The myocardial LPSS of left ventricular segment with good or reduced perfusion was significantly higher at six months after delayed PCI (t=13.013,10.821,both P ＜ 0.001),but the LPSS of left ventricular segment with absent perfusion was similar to that of pre-PCI.Whether at one day prior to delayed PCI or six months after delayed PCI,there were significant differences in LPSS parameters among the three groups (at one day prior to delayed PCI,myocardial perfusion absent vs reduced or good,t=4.201 and 11.771,both P ＜ 0.001;myocardial perfusion reduced vs good,t=12.561,P ＜ 0.001;at six months after delayed PCI,myocardial perfusion absent vs reduced or good,t=9.714 and 15.646,both P ＜ 0.001;myocardial perfusion reduced vs good,t=9.254,P ＜ 0.001).The LPSS both at one day prior to delayed PCI and six months after delayed PCI in myocardial perfusion good group ＞ those of myocardial perfusion reduced group ＞ those of myocardial perfusion absent group.PSI was positively correlated with GLS at both one day prior to delayed PCI and six months after delayed PCI (r=0.69,0.72,both P ＜ 0.001).MPS was positively correlated with LPSS at both one day prior to delayed PCI and six months after delayed PCI (r=0.49 and 0.45,both P ＜ 0.001).Conclusion Myocardial perfusion before delayed PCI,monitored by MCE,is correlated well with myocardial systolic function,and may be used to predict the recovery of myocardial systolic function after delayed PCI.
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Objective To probe the relationship between Helicobacter py lori(Hp) IgG antibody components and coronary heart disease(CHD). Meth ods Hp serum specif ic IgG antibodies (Hp-IgG) and antibody components were measured by immunoblot ( IBT) methods in 209 CHD patients and 191 healthy controls from Mar.2001 to Sep 2 003. Results Of the 209 patients with CHD, 152(73%) were serop ositive to Hp comp ared with 113(59%) of the 191 healthy controls(P=0.0042). The Hp antibody co n tained different antibody components, such as cytotoxin-associated gene product A (CagA), vacuolating cytotoxin protein A (VacA), urease A (UreA), urease B (UreB ) etc,and only seropositivity to component UreB66 in CHD group was significantl y higher than that in healthy control (P=0.0001). Multiple Logistic Regression analysis revealed that the Hp antibody component UreB66 was significantly correl ated with CHD (P
