| Objective:Acute Myocardial Infarction(AMI)is serious myocardial ischemia and necrosis and other pathological changes in the corresponding blood supply area due to a sharp reduction in the total amount of coronary blood supply,severe or even complete disruption.Rapid,accurate and quantitative measurement of left ventricular function in patients with acute myocardial infarction has great clinical significance to clinical diagnosis of myocardial infarction range,selection of specific clinical treatment program and evaluation of treatment effect as well as the prognosis of patients with disease and so on.At present,echocardiography has a variety of methods to evaluate left ventricular systolic function.There are M-mode echocardiography,two-dimensional echocardiography(2DE),tissue Doppler(Tissue Doppler Imaging,TDI),Two-Dimensional Strain(2DS)and Three-Dimensional Speckle Tracking Imaging(3D-STI).Because ultrasound three-dimensional speckle tracking technology can simultaneously meet the synchronization of myocardial exercise time and space,but also accurate measurement and quantitative evaluation on the three-dimensional cardiac mechanics and other physiological phenomena,and its clinical application has become more and more widely.At present,there are few studies on the correlation between the three-dimensional speckle tracing technique and acute myocardial infarction as well as the correlation between the left ventricular myocardium strain and the left ventricular systolic function in patients with acute myocardial infarction.Therefore,this study aim to apply three-dimensional speckle tracking technique to evaluate the relationship between the left ventricular myocardium and the left ventricular systolic function and to evaluate the relationship between correlation between the left ventricular myocardium strain and the left ventricular systolic function in patients with acute myocardial infarction in order to guide the three-dimensional speckle tracing technique in the diagnosis of acute myocardial infarction.Methods:30 patients with acute myocardial infarction who underwent outpatient or hospitalization at department of cardiovascular medicine and emergency from October 2014 to October 2016 were enrolled in this study while 30 outpatients were selected as the control group.Three-dimensional speckle tracing technique was used to detect the patients in acute myocardial infarction and outpatient with physical examination.The success rate of strain parameters in the left ventricle at two groups was compared;The systolic peak strain of basal segment,middle segment and apex cordis area were measured in the acute myocardial infarction group and control group;the basic parameters of the acute myocardial infarction group and control group(left atrial diameter,interventricular septal thickness,left ventricular end diastolic diameter,left ventricular end-diastolic diameter,left ventricular posterior wall thickness and left ventricular ejection fraction)were compared;systolic peak strain(Total longitudinal strain,overall circumferential strain,overall radial strain and total area strain)in the acute myocardial infarction group and control group were compared;The ROS was used to analyze the three-dimensional speckle tracking parameters of the acute myocardial infarction group.The correlation and consistency between the subjects of each groups were analyzed.The relationship between the left ventricular systolic peak strain and the left ventricular ejection fraction was analyzed.Results:There were no significant differences in gender,age,height,weight,systolic blood pressure,diastolic blood pressure and heart rate between acute myocardial infarction group and control group(P>0.05);30 cases of acute myocardial infarction group and 30 cases of outpatient with health examination showed 520 segments,the three-dimensional ultrasonography showed that the image quality was poor and failed to be traced,thus the number of 3D strain values segment was 21 and 22 respectively,the successful tracking rate of left ventricular segmental strain parameter values in acute myocardial infarction group was(95.9%,489/510)which had no significant difference(P>0.05)compared with that of the control group(95.7%,488/510)(P>0.05),and the basal segment side wall,posterior wall,inferior wall and posterior septum in inferior wall myocardial infarction group were significantly lower than those in the control group(P<0.05).The peak systolic peak strain in the anterior septum,anterior wall,inferior wall and posterior septum of the anterior myocardial infarction group were significantly lower than that of the control group(P<0.05).The peak systolic peak strain in the middle anterior septum,posterior wall,inferior wall and posterior septum of the inferior myocardial infarction group was significantly lower than that of the control group(P<0.05),The peak systolic peak strain of apex cordis anterior wall,inferior wall,apex cap and interventricular septum in myocardial infarction group were significantly lower than those in the control group(P<0.05).while the peak systolic peak strain of apex cordis inferior wall and interventricular septum in inferior wall myocardial infarction group(P<0.05);The left atrial diameter,ventricular septal thickness,left ventricular end diastolic diameter,left ventricular end-diastolic diameter and left ventricular posterior wall thickness in acute myocardial infarction group were significantly higher than those in control group(P<0.05).The left ventricular ejection fraction of the acute myocardial infarction group was significantly lower than that of the control group(P<0.05).The overall longitudinal strain,the overall circumferential strain,the overall radial strain and the whole area strain were significantly lower in the acute myocardial infarction group than those in the control group(P<0.05).The results from ROC analysis of three-dimensional speckle tracking technology parameters showed that the sensitivity of whole area of strain diagnosis for the left ventricular overall systolic function was 96.7%in the acute myocardial infarction group,which was higher than the overall longitudinal strain diagnostic sensitivity(93.3%),the overall circumferential strain diagnostic sensitivity(90.0%),the overall radial strain diagnostic sensitivity(80.3%)and left ventricular ejection fraction diagnostic sensitivity(70.0%).The overall longitudinal strain,the whole circumferential strain,the whole radial strain and the whole area strain peak value of the three-dimensional speckle tracking technique in the acute myocardial infarction group were negatively correlated with left ventricular ejection fraction between each groups(P<0.05).The overall radial strain systolic peak in the acute myocardial infarction group were negatively correlated with the left ventricular ejection fraction(P<0.05).Conclusion:Three-dimensional speckle tracking technique has a high success rate of strain parameter tracking for left ventricular segment in acute myocardial infarction;The application of three-dimensional speckle tracking technique can detect the abnormal exercise of myocardium in patients with acute myocardial infarction,so to have a accurate and reliable evaluation on the whole left ventricular systolic function;The overall longitudinal strain,the overall circumferential strain,the overall radial strain and the overall area strain were correlated with the left ventricular ejection fraction in the acute myocardial infarction group;Three-dimensional speckle tracking technique for detection of acute myocardial infarction patients showed high consistency and correlation in terms of measurement parameters,which can obtain high repeatability;the sensitivity by whole area systolic peak strain to diagnosis of left ventricular total systolic function in patients with acute myocardial infarction can be ideal,which can be used as a new indicator for evaluation of cardiac function. |
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