| BackgroundAcute myocardial infarction (AMI) is myocardial necrosis caused by acute, persistent coronary artery ischemia. With the rapid development of China’s economy, the standard of the people’s material living is constantly improving, especially the acceleration of population aging and urbanization, the increasing incidence of AMI patients has become the current main cause of mortality and disability. Although the rapid development of AMI diagnostic and therapeutic methods, especially the widespread application of early reperfusion therapy, the mortality of AMI patients still increased annually. The condition of the AMI patient after percutaneous coronary intervention (PCI) was always recurrent, even worse and that increased the risk of sudden cardiac death. Therefore, the health authorities and public were beginning to realize that the current way based on the cardiac intervention and drug therapy mainly to cure the myocardial disease is not the best at all, the effect is limited and unsustainable. Cardiac rehabilitation (CR) was confirmed to improve the left ventricular systolic function in such patients, improve survival quality, further reduce the fatality rate, but there have been few studies related to early family level of cardiac rehabilitation program on the heart function of patients with such effects.The current noninvasive imaging evaluation method of left ventricular systolic function was echocardiography, radionuclide imaging, CT and magnetic resonance imaging (MRI). Because of the advantages of convenient and economic operation, be able to operate on the bedside, Echocardiography has become to be an important means to evaluate heart disease. But the independence of operation level of the operator, poor objectivity of examination results, and the semi quantitative only. Two-dimensional speckle tracking imaging (2D-STI) is the new method to assess the global and regional left ventricular myocardial function from the overall perspective, but it cannot keep track of myocardial spots outside the two-dimensional plane, the clinical application was restricted. In recent years the expansion of three dimensional speckle tracking imaging (3D-STI) was overcame the traditional echocardiography by the restriction of the myocardial deformation direction. It can objectively, accuratly reflect myocardial strain in longitudinal axis, radial axis and circumferential direction in three-dimensional space, which could provide the quantitatively assessment of global and regional left ventricular systolic function. Its accuracy in the assessment of cardiar function is better than that of conventional wall motion analysis and the left ventricular ejection fraction (LVEF). However, few studies to date have used 3D-STE to evaluate the regional and global left ventricular function of AMI patients in an early, short-term, home-based CR program. Furthermore, we speculate that the 3D-STI can be more sensitive to assess the cardiac function for the short-term CR program.ObjectiveThe purpose of our study, therefore, was to compare the global and segmental myocardial function of AMI patients after PCI in an early, short-term, home-based CR program with the global and regional left ventricular systolic function of the control group using 3D-STE. The CR program was initially conducted with supervised inpatient CR training, followed by an unsupervised home-based exercise training program during a follow-up period of one months.MethodsSixty ST elevation AMI patients (aged between 18-65 years old) admitted to Cardiovascular Department of the General Hospital of Guangzhou Military Command of People’s Liberation Army (PLA) between November 2014 and March 2015 were enrolled in our study. According to whether the patients were willing to participate in a CR program, the AMI patients were divided into the rehabilitation group (30 cases) and control group (30 cases). All the subjects were received emergency PCI surgery, and were given the treatment of secondary prevention strategy of coronary heart disease after PCI. The patients in the rehabilitation group were asked to take part in the four-week early CR program, followed closely management. The control group only received routine care. All patients were examined by 3D-STI to collect the left ventricular global and segmental longitudinal strains(LS), radial strains (RS), circumferential strains (CS), area strains (AS) and LVEF at the beginning of the study and after four weeks of follow-up. For segmental strain assessment, the myocardium was divided into several segments based on the results of the CAG. The perfusion region of the PCI location and the distal part from stented segments was defined as the interventional segment; The perfusion region of coronary artery stenosis≥50%in diameter without intervention and its distal part was defined as the ischemic segments, and the remaining segments were defined as normal segments.Results①From groups of clinical data, sex, age, BMI, CHD risk factors, coronary artery disease, medication and 3D ultrasound data comparison of the patients between the rehabilitation group and the control group showed no statistical significance(p>0.05)②At the global level, the global longitudinal strain(GLS), global circumferential strain (GCS), global radial strain (GRS), and LVEF was significantly higher after 4 weeks of rehabilitation program in rehabilitation group than at the baseline, compared with the control group, and the difference was statistically significant(p＜0.05).③According to the left ventricular segmental dividing, each 510 segments were obtained from the rehabilitation group and the control group. In the rehabilitation group, the 183 segments were defined as the intervention segments,109 segments were defined as ischemic segments, and the remainder as normal segments; while in the control group, the 195 segments were defined as the intervention section,112 segments were defined as ischemic segments, and the remainder as normal segments. The comparison of segmental strains of the intervention segments, ischemic segments, and normal segments between the rehabilitation group and the control group at the baseline showed no statistical significance(p＞0.05).Segmental strains of the intervention segments, ischemic segments, and normal segments in the rehabilitation group were all significantly higher at the end of the follow up than at baseline, compared with the control group, and the difference was statistically significant(p＜0.05).ConclusionAn early CR program could improve the left ventricular global and segmental systolic function of AMI patients after PCI within short period of time. Our study suggests that an early, home-based CR program is an excellent and convenient program and appears to be the preferred choice for most patients. Moreover, the technique of 3D-STI is a reproducible and efficient tool to evaluate myocardial function. |
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