| Aim:To conduct a follow-up study with RT-3DE on the indexes of left ventricle systolic function and time-column curve in patients diagnosed as acute myocardial infarction of anterior wall and treated with PCI, as well as the activity of angiotoninⅡreceptor, in an attempt to discuss the effect of PCI, and the correlation between these indexes.Materials and methods:1. Object:The objects include 100 patients, admitted to our hospital between 2009 and 2010, diagnosed as acute myocardial infarction of anterial wall and treated with PCI, which were randomly divided into two groups. Group A include 50 cases, who received intravenous injection of urapidil, aα-adrenaline receptor blocker before operation and oral medication of valsartan,a angiotoninⅡreceptor blocker. Group B include 50 cases, who received treatment with tirofiban, a plateletⅡa/Ⅲb receptor blocker. And then, the above two groups were further divided into group A1,A2,B1,B2 according to with or without reflow.2.Detection Method:All cases were dected with 3 dimenson echocardiogram in 1 week,1 month,3 months,6 months after PCI. The obtained images were stored in hard disc for off-line quantitative analysis with Qlab 6.0 3DQ Advance software, which could automatically generate the time-column curves of the whole left ventricular and 17 segments, left ventricular 17 segments bull's eye pattern and related indexes(including end-diastolic dimension, end-systolic volume and ejection fraction of the whole left ventricular and each segment, as well as segment-whole ejection fraction) and calculate the peak ejection rate of the left ventricular (PER), standardized to PER/EDV and PFR/EDV. The blood samples were collected from coronary sinus and peripheral vein of the patients post PCI to detect the activity of angiotoninⅡreceptor by ELISA.3. Statistical analysis:Dates were analyzed with SPSS11.3 software and the results were expressed as mean±SD. t test was used for the comparison between means of different groups and linear correlation analysis was employed to detect the correlation between indexes. P<0.05 was determined as with statistical significance. Results:EDV and ESV of group A1 and group B1 were higher compared to that of group A2 and group B2(p<0.05). The whole EF,rEF and rgEF were lower than that of A2,B2, and PER/EDV and PFR/EDV were also lower than that of group A2,B2(p<0.05). Furthermore, significant positive correlation was determined between PER/EDV, PFR/EDV and EF, between PER/EDV and PFR/EDV. The volume-time curves of 17th segments in group A1 and group B1 run smoothly and the amplitudes were low in each segment. Backward wave could be detected in the curve of the segment without reflow, in confused and disordered manner, and the trough phase for each segment was different. The wave trough of the segment near the reflow area was superficial, and those of the distal ones were deeper. The volume-time curve showed significant improvement in the movement of group A2 and B2 in infarct and the nearby segments. The EDV and ESV of A2 and B2 were decreased and EF was increased significantly after the treatment. Positive correlation was determined between the activity of angiotoninⅡreceptor and EDV,ESV, while negative correlation was determined between the activity of angiotoninⅡreceptor and EF and REF.Conclusion:(1)The myocardial damage in patients with no coronary artery reflow post PCI is severe, with broad area of infarct myocardium and the myocardial on the edge of infarction, increase in left ventricular end diastolic volume and end-systolic volume, expansion and reconstitution of the left ventricular, and decrease in the systolic function.(2)The increased activity of angiotoninⅡreceptors could induce the contraction of the vessels and capillaries, resulting in no reflow.(3)α-adrenaline receptor blocker and angiotoninⅡreceptor blocker could effectively reduce the onset of no reflow.
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