The Assessment Of Different Therapeutic Effect In Patients With Acute Myocardial Infarction By Tissue Motion Annular Displacement

Objective:To quantitative evaluate the left ventricular (LV) systolic function and assess the different therapeutic effect in patients with ST-segment elevation myocardial infarction (STEMI) by tissue motion annular displacement (TMAD).Methods:60patients with STEMI (AMI group) and30patients excluding coronary heart disease by the way of coronary angiography (control group) were enrolled in the study. According to the position of myocardial infarction, AMI group were divided into anterior myocardial infarction group (n=30), which include extensive anterior AMI, anteroseptal AMI and lateral AMI, and inferior myocardial infarction group (n=30), which include inferior AMI, posterior AMI and right ventricular AMI. Then AMI group were divided into emergency percutaneous coronary intervention (PCI) group (n=30), selective PCI group (n=20) and conservative treatment group (n=10) according to the gived therapeutic methods. Do a follow-up on average of8.15±1.48months in patients with AMI.To do the conventional two-dimensional echocardiography by Philips IE33ultrasound diagnostic applications, and the data including the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LA) and left ventricular ejection fraction (LVEF) were measureed. The TMAD parameters including the maximal displacement of the six points (posteroseptal AP4-PI, lateral AP4-L, anterior AP2-A, inferior AP2-I, anteroseptal AP3-AI and posterior AP3-P regions), the maximal displacement of the midpoint connecting the two points (AP4-M, AP2-M and AP3-M) and the ratio of the maximal displacement of the midpoint accounted for length diameter (AP4-FSL, AP2-FSL, AP3-FSL) in Apical four-chamber, two-chamber and vertical long axis view were acquired by Qlab software..All the datd were analyzed with the SPSS17.0software.Results:1. LVEDD, LVESD and LA were significantly increas in AMI group compared with control group, LVEF and the TMAD parameters were significantly decreased in AMI group compared with control group, P<0.01for all.2. There was a good correlation between the TMAD parameters and LVEF, the correlation between AP4-FSL and LVEF was the highest (r=0.908, P<0.01).3. AP3-AI and AP2-A were significantly decreased in anterior group compared with inferior group; AP3-P and AP2-I were significantly decreased in inferior group compared with anterior group, P<0.01for all.4. There were no significant difference in the basic clinical data, conventional data of two-dimensional echocardiography and TMAD parameters among the emergency PCI group, selective PCI group and conservative treatment group three groups in the hospitalization period (P>0.05). While LVEF and TMAD parameters were significantly increased, LVEDD and LVESD were significantly decreased in the emergency PCI and selective PCI group (P<0.01). but there was no difference in the degree of improvement (P>0.05) during the follow-up period. These parameters were no significant change in the conservative treatment group (P>0.05).Conclusion:1. A diminished mitral annular displacement was showed in the position of myocardial infarction, which suggests TMAD parameters may reflect the stenosis of corresponding coronary ateral, but it remains to be further research.2. The TMAD parameters and LVEF improved in the emergency and selective PCI group and there was no difference in conservative treatment group during the follow-up period,. Therefore PCI should be recommended in the AMI patients and TMAD can quantitatively assess the different therapeutic effect in AMI patients.3. There was positive correlation between the parameters of TMAD and LVEF and the correlation coefficients of AP4-FSL is the highest, so they may act as one of quantitative indexes to evaluate the left ventricular global systolic function.4. The conclusion requires further research because of the small sample size.