Evaluation Of Early Cardiac Rehabilitation Exercise On Ventricular Remodeling After PCI In Patients With Acute Myocardial Infarction By Two-dimensional Speckle Tracing Technique

Objective: Two-dimensional spot tracking technology is applied to evaluate the ventricular remodeling of the patients after emergency surgery for acute myocardial infarction,some of who do heart rehabilitation exercises in 12 hours and the other of who do heart rehabilitation exercises after 12 hours.Method:(1)The study includes 90 patients with acute ST-elevation myocardial infarction who are treated for emergency intervention and meet the criteria for heart rehabilitation.Some of them are treated in 12 hours and the others after 12 hours.(2)Cardiac ultrasonography are performed on the patients in 24 hours and 3 months after emergency interventional therapy.The items to be tested include left ventricular ejection fraction(LVEF),left ventricular endsystolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular diastolic diameter(LVIDd),left ventricular systolic diameter(LVIDs),peak velocity ratio of mitral valve ring wall(E’/A’),mitral valve early diastolic blood flow and atrial systolic peak velocity ratio(E/A).and Tei index.Two-dimensional speckle tracing technique was used to detect the shrink strain of the left ventricular segments,sections and the total longitudinal peak,and the circumferential strain of the left ventricular segments,sections and the total peak.The changes of the above indexes were analyzed after three months of cardiac rehabilitation.Result:(1)The data of a total of 84 patients are collected.42 patients of them(A group)do heart rehabilitation exercises in 12 hours after emergency surgery for acute myocardial infarction and the others(B group)after 12 hours.(2)Compared with the B group,the changes of longitudinal longitudinal peak systolic strain in left ventricle of the he A group is greater.(P<0.05).Segmental longitudinal peak shrinkage strain of the A group is greater than the B group in the slices of two chambers and four chambers,anterior apical segment,sidewall middle section,cutting edge and middle section of interventricular septum.(3)There was a significant difference between the two groups in the peak shrinkage of the circumferential strain value of anterior mitral valve level,posterior apical level and posterior interval of mitral valve levels.But the changes of circumferential strain value of left ventricular total peak shrinkage between the two group isn’t statistically significant.(4)There is no big difference between the two groups in LVEF,LVESV,LVEDV,LVIDd,LVIDs,E’/A’,E/A.and Tei index(P>0.05).(5)During the two-month heart rehabilitation,the number of the patients who have chest discomfort,go to outpatient clinic,hospitalize again,or die are almost the same(P>0.05).Conclusion:(1)Two-dimensional speckle tracking longitudinal peak shrinkage strain technique can early reflect the shape of the ventricle and local and overall functional changes in the myocardium after acute myocardial infarction.And it is more sensitive than the indexes of shrinkage peak circumferential strain,LVEF,LVESV,LVEDV,LVIDd,LVIDs,E’/A’,E/A,Tei index and so on.(2)After acute myocardial infarction,it is better to have cardiac rehabilitation as early as possible for the patients without heart rehabilitation contraindications to relieve their left ventricular deformation,the local and overall function of the myocardium.(3)Spot tracking technology can be a sensitive method to detect left ventricular early remodeling after myocardial infarction(4)When the longitudinal peak shrinks strain value is equal to or more than-16.5,the specificity of ventricular remodeling after diagnosis of infarction was 98.3% and the sensitivity is 82.9%.(5)In strict accordance with the requirements of cardiac rehabilitation,it is safe to have acute myocardial infarction patients do heart rehabilitation exercises as soon as possible.