| Early and completely reperfusion infarction related vessel after acute myocardial infarction(AMI) can recover myocardial perfusion, limit infarction size. increase survival myocardium . protect myocardial function and decrease mortality.At present the common methods conclude thrombolysis and PCI.This study using the ATP stress echocardiography and pulsed-wave Doppler Tissue Imaging(PWDTI) analyses the characteristics of mitral annulus'PWDTI parameters of postinfarction patients and relation with traditional myocardial function index,estimate the effect of different therapy.34 patients were divided into PCI group(27 cases) and thrombolysis group (7 cases).ATP stress echocardiography (ATP 140ug.kg"'.min"l,6 min) and PWDTI of mitral annulus were performed one month after onset of acute myocardial infarction. Results:1 .The general echocardiography parameters of left ventricular Compared with thrombolysis,PCI group had higher EF. E. A and E/A under resting and stress situation.Butjthere was no significant difference between the two groups.There were higher trendacy of EF. E. A and E/A and decreased trendacy of LA and LV after given ATP in PCI group but no significant differenceLA . EF. E and A significantly enlarged (p < 0.05)and E/A decreased after given ATP in thrombolysis group.2.Analysis of wall motion There were 27 of 47 and 6 of 17 hypokinetic segments recovering in PCI group and thrombolysis group respectively after given ATP.The akinetic segments of both groups had no changes.The wall motion score(WMS) and wall motion score index of PCI group decreased significantly (p <0.05)after given ATP,and them of thrombolysis group also decreased but there was no significant difference.3.PWDTI parameters of mitral annulusl)The feature of mitral annulus' PWDTI parameters of myocardial infarction patients:Contrast to normal subjects,velocity. time and velocity-time integral parameters of mitral inner. outer and posterior annulus of infarction patients significantly decreased(p<0.05),especially systolic and diastolic functionparameters.There were positive correlations between e/a of mitral annulus and E/A of mitral blood flow in which the correlation between e/a of mitral outer annulus and E/A is the closest(p<0.05).Therefore there were no correlation between Vs of mitral annulus and left ventricular ejection fraction(EF).2)Comparision between the two groups:There were no significant difference of mitral annulus PWDTI parameters between the two groups under resting and stress situation.But,systolic and diastolic function parameters(Vs, VTIs, Ve, VTIe, Va and VTIa et al) of PCI group seemingly had higher tendacy than them of thrombolysis group.Pre and post drug test dispersion of peak systolic velocity(As) and peak early diastolic velocity (Ae) of mitral annulus were significantly different between PCI and thrombolysis groups(p<0.05).3)Self-comparision of each groups:Vs, Ve, Va, Ds, De, Da, VT^ VTIe and VTIa of mitral annulus were all significantly improved after given ATP in PCI group(p<0.05).But,FVC shortened.Eight cases of PCI group followed up 3 monthsrlVC of them shortened;Vs, VTIs, Va of mitral inner annulus,Ve of outer annulus and De of posterior annulus all enlarged(p<0.05).After given ATP,Vs, Va, VTIs, VTIa of mitral annulus of thrombolysis group all raised but Ve, VTIe and e/a had lower tendacy.4. Changes of hemodynamics and safety:After infused ATP intravenously,systolic and diastolic blood pressure decreased but the changes had no significance.The heart rate increased significantly.There were no severe side effects during ATP stress echocardiography.Common discomfort symptoms concluded dyspnea, palpitation, headache, sweating and flushing et al.These minor side effects were often well tolerated by patients and quickly disappeared after ceasing infusion ATP. Conclusion:l.Appling PWDTI combined with ATP stress echocardiography can evaluate the effect of different therapy.PWDTI parameters of postinfarction patients have obvious characteristics.PWDTI parameters of mitral annulus are more accurate an... |
