Evaluate The Changes Of Left Ventricular Function In Patients With AMI Before And After Emergency PCI By Quantitative Tissue Velocity Imaging

[Objective] To evaluate the changes of left ventricular systolic and diastolic functions in patients with acute myocardial infarction (AMI) before and after emergency PCI byquantitative tissue velocity imaging (QTVI) of echocardiography with further to search sensitive indicators for estimating the clinical value of QTVI on diagnosing CHD. The technique of quantitative tissue velocity imaging (QTVI) is a new method can quantitative analyze the myocardium movement of different parts at the same time which based on TDI. [Method] There were 30 cases first diagnosed with AMI served as AMI group whose infarct-related artery (IRA) is left anterior descending coronary artery (LAD). 30 normal subjects were served as control group. Each segment of each wall of all cases and all subjects were measured the myocardial motion velocity by QTVI. Through comparing those indicators measured by both traditional echocardiography and QTVI for left ventricular systolic and diastolic functions, and the gold standard for the narrow extent of coronary artery estimated by CAG, the aim was to explore the correlations between the narrow extent of coronary artery and those indicators measured respectively by the two techniques mentioned above.[Results]1. There is no significant differences in sex, age, HR between control group and AMI group. Hypertensive patients in AMI group are more than control group, SBP is major.The differences have statistical significance(p<0.05).2. AMI compare with preoperative, the peak velocity at early diastole E,and with peak vel- ocity at late diastole A ratio-E/A, mitral annulus velocities during early diastole Ve-m,and with atrial contraction Va-m ratio, Ve-m/Va-m, Vs-m, LVEF reduced obviously(P<0.01or P<0.05), E/Ve-m,IRT increased obviously(P<0.01); AMI after PCI compare with before, E,E/A,Ve-m and Ve-m/Va-m,Vs-m,LVEF increased obviously, HR, E/Ve-m reduced obviously (P<0.01).3. The growing rate of Ve after PCI 1 , 3 months compared with before, anterior septum and anterior wall in mitral annulus got increased more significantly than other positions; The growing rate of Vs after PCI 1 month compared with before, posterior septum and posterior wall in mitral annulus got increased more significantly than other position; The growing rate of Vs after PCI 3 months compared with before, anterior septum and anterior wall in mitral annulus got increased more significantly than other positions4. This AMI group diastolic disfunction fulls slowly primarily, minority is pseudo normal, no limited. Isovolumic relaxation time prolongs when Ventricular diastolic disfunction is light, it shortens to the normal range when ventricular diastolic function is pseudo-normalization. After PCI most patients diastolic function restored to normal,minority is still pseudo normal.5. HR is negatively correlated to E/A, Ve-m/Va-m, Ve-m, IRT, correlated positively with E/Ve-m; Age and SBP are negatively correlated to E, E/A, Ve-m/Va-m is negatively correlated to E/A,Ve-m ,Ve-m/Va-m , correlated positively with E/Ve-m; SBP is correlated positively with E/Ve-m, IRT; Vs-m,LVEF are negatively correlated to E, E/A, Ve-m E/Ve-m,IRT; Vs-m, LVEF correlated positively with E,E/A, Ve-m ,Ve-m/Va-m, negatively correlated toE/Ve-m, IRT; DBP is not correlated to indicators of left ventricular function. HR, age, SBP, Vs-m, LVEF are effect factors of left ventricular function.6. The AMI group compared with control group, Ve of each segment of each wall reduced obviously(P<0.01); AMI after PCI 1 month compared with preoperative group, the velocity of anterior septum (AS) in midst,anterior wall(AW) in midst,inferior wall(IW) in base and midst increased(P<0.01 or P<0.05);AMI after PCI 3months compared with preoperative group, except for the lateral wall(LW) in midst, the other wall movement velocity increased in varying degrees(P<0.01 or P<0.05);AMI after PCI 3months compared with 1 months, except for LW in midst,AS in midst and posterior wall(PW) in base and midst, the others increased in varying degrees (P<0.01 or P<0.05), after PCI 3months compared with the control group, there were no significant changes(P>0.05) in the velocity of PW in midst ,AS in base and midst, PW in midst, IW in mitral annular and midst, AW the other wall movement velocity still reduced in varying degrees(P<0.01 or P<0.05).7.In the 4 groups divided by Gensini index, Age,HR have no significant differences. Gensini index has correlation with SBP,DBP,E/A,Ve-m,Ve-m/ Va-m,Vs-m,LVEF(P<0.01orP<0.05),was not correlated to E,E /Ve-m,LVDd,LVDs(P>0.05)8.SBP is correlated positively with Gensini index; E, E/A, Ve-m, Ve-m/ Va-m, Vs-m, LVEF are negatively correlated to Gensini index; Age, HR, DBP, E /Ve-m, LVDd, LVDs are not correlated to Gensini index.9. Multiple regression analysis suggested: SBP and LVEF are the independent determinants of Gensini index.[Conclusion]1. Left ventricular function of AMI reduced obviously, after PCI 3 months can be increased.2. The indexes of left ventricular diastolic function is more sensitive than systolic function of ischemia.3. Left ventricular diastolic function is negatively correlated to HR,Age,SBP, correlated positively with LVEF, E/Ve-m<10 when ventricular diastolic function is normal ,E/Ve-m>10 when ventricular diastolic function is abnormal; Isovolumic relaxation time prolongs when Ventricular diastolic dysfunction is light, it shortens to the normal range when Ventricular diastolic function is pseudo-normalization. E/Ve-m can be evaluated left ventricular diastolic function. E/ Ve-m, Ve-m /Va-m, E/A and joint IRT can accurately evaluate left ventricular diastolic function of patients with AMI after emergency PCI.4. Emergency PCI can improve left ventricular function of younger patients more obviously , regular treatment after PCI is very important to improve left ventricular function.5. Indicators measured by QTVI and traditional ultrasound are markly correlated to narrow degree of coronary. Left ventricular diastolic function unit systolic function can estimate AMI prognosis after PCI accurately.6. SBP and LVEF are the independent determinants of Gensini index, In CHD patients should be strictly controlled SBP, lower LVEF, more narrower coronary.