Evaluation Of Myocardial Mechanical Changes In Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention By Speckle Tracking Technique

Objective:To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction by ultrasonic speckle tracking technique,to investigate the recovery of left ventricular myocardium mechanics and the effects of common complications(hypertension or diabetes mellitus)on the improvement of myocardial mechanics.To provide a clinical basis for assessing the efficacy and prognosis of PCI in patients with acute myocardial infarction.Methods:62 patients with acute myocardial infarction,aged 43 to 71 years,mean(57 ± 6)years.Divided into three groups according to comorbidities: simple acute myocardial infarction group(21 cases),acute myocardial infarction with diabetes group(21 cases),acute myocardial infarction with hypertension group(20 cases).All patients underwent echocardiography within 12 hours after MI,within 1 week after PCI and 3 months after PCI.The normal control group was 30 healthy volunteers matched for age and sex.Left ventricular end-diastolic diameter(LVEDD)and end-systolic diameter(LVESD)were obtained by M-mode ultrasound.The left ventricular end-diastolic volume(2D-LVEDV,3D-LVEDV),left ventricular end-systolic volume(2D-LVESV,3D-LVESV)and left ventricular ejection fraction(2D-LVEF,3D-LVEF)were measured by biplane Simpson method and Real-time three-dimensional volume(RT-3DE).2D and 3D strain parameters of left ventricle were obtained by EchoPAC software.The routine and strain parameters of acute myocardial infarction group and normal control group were compared.The routine and strain parameters of different groups of acute myocardial infarction were compared.To campare degree of the routine and strain parameters before and after PCI.To campare degree of improvement of strain between different groups of acute myocardial infarction after PCI.Results:(1)Compared with the normal control group,LVEDD,LVESD,2D-LVEDV,3D-LVEDV,2D-LVESV and 3D-LVESV in the acute myocardial infarction group were larger;2D-LVEF,3D-LVEF,global longitudinal endocardial strain(GLS-endo),global longitudinal midcardial strain(GLS-mid),global longitudinal epicardial strain(GLS-epi),global circumferential endocardial strain(GCS-endo),global circumferential midcardial strain(GCS-mid),global circumferential epicardial strain(GLS-epi),two-dimensional left ventricular global radial strain(2D-LVGRS),three-dimensional left ventricular global longitudinal strain(3D-LVGLS),three-dimensional left ventricular global circumferential strain(3D-LVGCS),three-dimensional left ventricular global area strain(3D-LVGAS)were smaller(p <0.05).(2)GLS-endo,GLS-mid,GLS-epi,GCS-endo,GCS-mid,GCS-epi,2D-LVGRS,3D-LVGLS,3D-LVGCS,3D-LVGRS and 3D-LVGAS of acute myocardial infarction with diabetes group were less than those in simple acute myocardial infarction group and acute myocardial infarction with hypertension group(p<0.05).The acute myocardial infarction with hypertension group had less GLS-endo than simple acute myocardial infarction group(p<0.05).There was no significant difference in the conventional parameters among the different groups of acute myocardial infarction(p>0.05).(3)Compared with the parameter before PCI and one weeks after PCI,2D-LVESV and 3D-LVESV for patients of AMI three months after PCI were smaller(p<0.05);2D-LVEF,3D-LVEF and GLS-endo,GLS-mid,GLS-epi,GCS-endo,GCS-mid,GCS-epi,2D-LVGRS,3D-LVGLS,3D-LVGCS,3D-LVGRS and 3D-LVGAS were larger;There was no significant difference for LVEDD,LVESD,2D-LVEDV and 3D-LVEDV(p>0.05).There was no significant difference before PCI and one weeks after PCI about routine and strain parameters(p>0.05).(4)Comparison of the degree of improvement for myocardial mechanics in three months after PCI between different groups of acute myocardial infarction,the degree of improvement of global longitudinal endocardial strain(? GLS-endo)and global circumferential endocardial strain(? GCS-endo)in acute myocardial infarction with diabetes group was less than that in simple acute myocardial infarction group(p <0.05).The degree of improvement of global longitudinal endocardial strain(?GLS-endo)in acute myocardial infarction with hypertension group was less than that in simple acute myocardial infarction group(p <0.05).Conclusion:(1)Left ventricular myocardial mechanics impaired with reduced systolic function after acute myocardial infarction.(2)Myocardial mechanics in acute myocardial infarction patients with diabetes mellitus was worse than that in simple acute myocardial infarction patients and acute myocardial infarction patients with hypertension.(3)Myocardial mechanics in acute myocardial infarction 3 months after PCI improved significantly compared with that before operation and one week after operation,and there was no significant improvement in one week after PCI.(4)The degree of improvement of myocardial mechanics 3 months after PCI in acute myocardial infarction with diabetes mellitus group and acute myocardial infarction with hypertension group was worse than simple acute myocardial infarction group.