低剂量多巴酚丁胺超声心动图检测心肌梗塞后可逆的功能障碍

应用低剂量多巴酚丁胺负荷超声心动图（LDDSE）试验对21例心肌梗塞患者梗塞区心肌功能障碍的可逆性进行研究。可逆的可能障碍是指室壁运动得到改善。结果表明静息超声心动图（RE）至LDDSE时室壁运动得分指数（WMSI）在急性心肌梗塞（AMI）从1．83±0．32下降到1．45±0．19（P＜0．01）；而陈旧性心肌梗塞（OMI）从1．96±0．35下降到1．70±0．20（P＜0．05）。RE时336个节段中有82个节段室壁运动异常，LDDSE时46（56．1％）个节段室壁运动改善，7（8．5％）个节段室壁运动明显改善。提示心肌梗塞后梗塞区有存活心肌细胞成分。LDDSE试验能够简便准确地检测心肌梗塞后梗塞区心肌功能障碍的可逆性。     

小剂量多巴酚丁胺负荷超声心动图结合多普勒组织成像评价存活心肌的研究

目的：研究多普勒组织成像（DTI）结合小剂量多巴酚丁胺负荷超声心动图评价心肌活性的可行性，并研究其与^99mTc-MIBI硝酸甘油介入心肌显像在评价存活心肌方面的一致性。方法：对30例经冠状动脉造影确冠心病的患者行超声心动图及心脏核素检查，超声心动图检查使用DTI速度模式，采用两级多巴酚丁胺超声心动图试验，所有患者均行静息显像及硝酸甘油介入后显像，结果：（1）30例冠心病患者用超声心动图静息DTI检测480个室壁节段，检出166个运动常节段，运动减弱节段108个，运动消失节段58个。（2）对患者行超声心动图小剂量多巴酚丁胺负荷试验DTI检测480个室壁节段，检出166个运动异常节段中89个节段运动改善，提示为存活心肌节段（A组）；余77个节段无变化，为坏死心肌（B组）。A组静息及负荷超声心动图DTI差异有显著性意义（P＜0．05），B组静息及负荷超声心动图DTI差异无显著性意义（P＞0．05）。A组与B组静息超心动图DTI差异无显著性意义（P＞0．05）。（3）30例冠心病患者用^99mTc-MIBI硝酸甘油介入心肌显像检测480个室壁节段，检出185个病变节段，其中97个为存活心肌节段，小剂量多巴酚丁胺结合超声心动图DTI诊断存活心肌的敏感性达83％，特异性达86％，结论：DTI结合小剂量多巴酚丁胺是评心肌活性的一项超声新技术，其结果与^99mTc-MIBI硝酸甘油介入心肌显像进行对照分析显示良好的一致性，应用前景较为乐观。     

改良硝酸甘油法介入^99mTc—MIBI心肌显像检测存活心肌的观察

目的：研究49例心肌梗塞患者PTCA术前及术后2－3个月进行药物介入核素心肌显像,研究改良硝酸甘油法（简称改良硝甘法）介入^99mTc-甲氧基异丁基异腈心肌显像对存活心肌的检测。方法：分别对33例改良组及16例普通组的心肌梗塞患者进行了静息－改良硝甘法和静息－普通硝甘法介入心肌显像,并于术后2－3个月重复显像。结果：改良组静息显像异常节段97个,改良硝甘法介入后有62个节段再填充,再填充率63．9％;普通组静息显像异常节段51个,普通硝甘法介入后有24个节段再填充,再填充率47．1％;两组差异有显著意义（P＜0．01）。经皮血管再通术后复查静息心肌显像,与术前硝甘法显像比较,灌注改善的预测准确率为90．7％和70．6％。结论：改良硝甘法介入可明显提高对存活心肌检测的灵敏度和特异性,且副作用少。     

小剂量多巴酚丁胺- 硝酸甘油超声心动图试验检测存活心肌的研究

目的 评价小剂量多巴酚丁胺－硝酸甘油超声心动图（ＤＮＥ０检测存活心肌的临床价值。方法 心肌梗塞后伴节优性室壁运动异常患者３６例,接受梗塞相关血管经皮３腔内冠状动脉成形术（ＰＴＣＡ）前进行ＤＮＥ试验。ＰＴＣＡ后随访９个月,将ＤＮＥ识别为存活心肌的室壁节段与实际运动改善节段做对比判定ＤＮＥ检测存活心肌的准确性。结果 ＤＮＥ检测存活心肌的敏感性、特异性及准确性分别为８０％、８１％及８２％。结论 ＤＮＥ为     

低剂量多巴酚丁胺负荷超声心动图时急性心肌梗塞患者室壁运…

为探讨低剂量多巴酚丁胺负荷超声心动图（ＬＤＤ，ＳＥ）对急性心肌梗塞患者室壁运动障碍自发性改善的预测价值，对２７例初发急性心肌梗塞患者（溶栓治疗９例，Ｑ波型心肌梗塞２２例）于发病后一周内行静息二维超声心动图检查及ＬＤＤＳＥ试验，分别对静息，ＬＤＤＳＥ试验时和４个月后随访时的室壁运动障碍进行室壁运动评分，ＬＤＤＳＥ试验时，室壁运动障碍的节段较静息时改善≥１级者，为有存活性的梗塞节段，随访时室壁运动障碍     

超声心动图在激光心肌打孔血运重建术中的作用

对８例有陈旧性心梗（ＯＭＩ）并不稳定心绞痛的患者进行激光打孔血运重建术（ＴＭＬＲ）术前、术中及术后的超声心动图评估。术前ＴＴＥ发现８例患者均有与ＯＭＩ报道部位一致的节段室壁运动异常。５例术前行多巴酚丁胺负荷超声（ＤＳＥ）检查，２例小剂量负荷时有室壁运动改善，３例在大剂量时，发现新的节段室壁运动异常或原有室壁运动异常加重。术中ＴＥＥ检查５例，监测打孔成功率７５％。术后随访，虽然所有存活患者临床症状明显改善，但复查超声静息状态下未发现ＬＶＥＦ及室壁运动指数的明显改善，这可能与ＴＭＬＲ治疗后仅导致心内膜下亚区域心肌灌注改善有关。     

改良硝酸甘油法介入~(99m)Tc-MIBI心肌显像检测存活心肌的观察

目的 :通过 49例心肌梗塞患者PTCA术前及术后 2～ 3个月进行药物介入核素心肌显像 ,研究改良硝酸甘油法 (简称改良硝甘法 )介入99mTc 甲氧基异丁基异腈心肌显像对存活心肌的检测。方法 :分别对 33例改良组及 16例普通组的心肌梗塞患者进行了静息 -改良硝甘法和静息 -普通硝甘法介入心肌显像 ,并于术后 2～ 3个月重复显像。结果 :改良组静息显像异常节段 97个 ,改良硝甘法介入后有 6 2个节段再填充 ,再填充率 6 3 9% ;普通组静息显像异常节段 5 1个 ,普通硝甘法介入后有 2 4个节段再填充 ,再填充率 47 1% ;两组差异有显著意义 (P <0 0 1)。经皮血管再通术后复查静息心肌显像 ,与术前硝甘法显像比较 ,灌注改善的预测准确率为 90 7%和 70 6 %。结论 :改良硝甘法介入可明显提高对存活心肌检测的灵敏度和特异性 ,且副作用少     

心肌梗死患者负荷三维超声心动图与冠脉介入治疗结果的对照分析

目的 对心肌梗死患者行多巴酚丁胺负荷三维超声心动图试验,与经皮冠状动脉介入治疗后的结果相对照以判断心肌梗死患者的存活心肌. 方法 研究对象共80例,其中正常组40例,心肌梗死组40例[含左前降支(LAD)病变21例、左回旋支/右冠(LCX/RCA)病变11例、多支病变8例],三维超声心动图检查行左室三维重建,将左心室分为17个节段;心梗患者行经皮冠状动脉介入治疗(PCI),术后复查三维超声,与术前比较整体射血分数(EF)值改善＞5％为存活心肌组、EF值改善≤5％为无存活心肌组;心梗组行多巴酚丁胺负荷三维超声检查,比较负荷试验前后左室整体EF及左室壁各节段的EF值. 结果 (1)正常组左室壁节段的EF值52％～79％;LAD、LCX/RCA、多支病变相关节段EF值均明显低于正常组相对应节段EF值(P＜0.01).(2)心梗患者于PCI术后3周～1个月复查超声心动图,存活心肌组(33例)左室整体EF值术前、术后为(43±11)％对(47±8)％,改善9％,冠脉病变区相关节段EF值为(34±10)％对(42±15)％(P＜0.0l);无存活心肌组(7例)EF值术前、术后为(37±9)％对(38±10)％,改善≤5％,冠脉病变区相关节段EF值为(25±l0)％对(24±12)％(P＞0.05).(3)心梗组术前行多巴酚丁胺负荷三维超声试验,存活心肌组负荷试验前、后左室整体EF值为(43±11)％对(50±9)％(P＜0.05),冠脉病变区相关节段EF值为(34±10)％对(48±16)％(P＜0.01);无存活心肌组负荷试验前后左室整体EF值为(37±9)％对(39±7)％(P＞0.05),冠脉病变区相关节段EF值为(25±10)％对(27±13)％(P＞0.05),负荷三维超声的结果与PCI术后随访结果相吻合. 结论 心肌梗死后,多巴酚丁胺负荷三维超声心动图的检测结果与PCt术后随访结果相关性良好,利用多巴酚丁胺负荷三维超声心动图检测存活心肌客观、定量化,避免了二维负荷超声心动图试验主观性.     

经静脉实时心肌造影超声心动图评估心肌梗死后存活心肌

目的探讨经静脉实时心肌造影超声心动图（RT-MCE）评估心肌梗死后存活心肌。方法18例准备进行血运重建术心肌梗死患者,于术前1-5天行RT-MCE检查,并于术后3个月再次行常规超声心动图检查,室壁运动分析采用18节段分析法,分为运动正常、运动减弱、无运动和反常运动。心肌存活定义为术后超声检查室壁运动明显改善。将造影结果分为3种情况：充盈缺损,造影剂充盈延迟、回声稀疏不均匀或心内膜下充盈缺损,回声均匀性增强。其中后两种情况定义为存活心肌。结果在18例心肌梗死患者中共检出109个室壁运动异常节段,运动减弱为47个,无运动为56个,反常运动为6个。注射造影剂后回声均匀性增强的心肌节段中有2个节段术前室壁运动减弱,术后运动均改善;回声不均匀或心内膜下充盈缺损的心肌节段中术前室壁运动减弱有24个节段,术后运动改善14个,术前室壁无运动有24个节段,术后运动改善20个;充盈缺损的心肌节段中术前室壁运动减弱有21个节段,术后运动均未改善,术前室壁无运动32个,术后运动改善2个。RT-MCE检出存活心肌的敏感性、特异性分别为94.7%、78.9%。结论RT-MCE能比较准确的判断心肌梗死后心肌的存活性。     

硝酸甘油介入心肌断层显像对存活心肌的判断价值

目的探讨硝酸甘油介入心肌断层显像对心肌梗死（MI）患者存活心肌的判断价值。方法64例心肌梗死患者经皮冠状动脉介入治疗术（PCI）前行^99mTc-MIBI静息和硝酸甘油（NTG）介入心肌显像，术后3个月时复查静息心肌显像，并进行对比分析。结果64例患者静息显像共有232个节段（40．28％）心肌核素摄取异常，NTG介入心肌显像后有132个节段（56．90％）呈可逆性缺损，100个节段（43．10％）呈不可逆性缺损；PCI术后136个心肌节段（58．62％）心肌灌注得到改善，术前NTG介入显像显示的132个可逆性缺损节段，术后120个节段（90．91％）心肌灌注改善，术前NTG介入显像显示的100个不可逆性缺损节段，术后16个节段（16．0％）心肌灌注改善，二者比较差异有统计学意义（P〈0．05）；而26例无存活心肌的一组患者，上述指标在术前和术后差异无统计学意义（P〉0．05）。结论MI患者PCI前常规行NTG介入^99mTc-MIBI心肌显像对是否进行PCI治疗的病例选择有决策性指导作用。     

心肌背向散射积分参数评价存活心肌的临床研究

目的探讨心肌背向散射积分参数评估缺血后存活心肌的临床价值.方法应用二维超声心动图(2-DE)及背向散射联机分析技术,观测31例陈旧性前间壁心肌梗死患者血管重建术前后前间隔心肌节段运动状态、标化背向散射积分(%AII)、背向散射周期变异幅度(CVIB).结果血管重建术后,62个心肌节段中,45个节段有存活心肌,17个节段无存活心肌.与术前比较,术后45个有存活心肌节段的%AII明显降低(1.6±0.3vs2.3±0.5,P＜0.01),CVIB明显增高(7.2±1.1vs3.4±1.2,P＜0.01).术后有存活心肌节段的%AII及CVIB与无存活心肌节段差异存在显著性意义(均P＜0.05).结论IBS两个参数,即%AII和CVIB,可以区分存活心肌和非存活心肌,能检测梗死区存活心肌.     

多巴酚丁胺负荷多普勒组织超声心动图预测PTCA术后冬眠心肌功能改善的价值

目的：探讨PWDTI结合LDDSK预测PTCA术后冬眠心肌功能改善的价值。方法：采用PWDTI结合LDDSK测量36例陈旧性心梗患者(静息下观察82个室壁运动异常节段)PTCA术前1天静息下和负荷下室壁运动异常节段峰值收缩速度Vs，并计算负荷下S％增长。PTCA术后4～6周随访分析。结果：PTCA术后，46节段室壁运动改善，36节段室壁运动未改善。以S％＞35％为裁断值，PWDTI结合LDDSK预测PTCA术后室壁功能改善的敏感性86．9％、特异性86．1％、准确性86．6％、阳性预测值88．9％、阴性预测值83．8％。结论：脉冲多普勒组织成像结合多巴酚丁胺负荷超声心动图可识别冬眠心肌并准确地预测PTCA术后局部左室功能改善。     

负荷超声心动图对心肌梗死后存活心肌的识别与评价

目的采用小剂量多巴酚丁胺负荷超声心动图(LDDSE)对心肌梗死患者的存活心肌进行评估,评价心肌梗死后冠状动脉血运重建术(CRV)对有存活心肌和无存活心肌室壁运动、心室重构及心功能改善的恢复状况。方法 80例心肌梗死患者于CRV术前1周内行静息超声心动图和LDDSE,观察患者室壁运动异常节段的变化,评估存活心肌情况,并在CRV术后3~5个月内复查LDDSE。于术前术后测定左心室收缩功能,并进行对比分析。结果 LDDSE对室壁节段功能恢复情况的预测准确性为86.4%,术前LDDSE检测的心肌节段数与术后左室舒张末容积(LVEDV)呈显著正相关(r=0.47,P﹤0.05),CRV术后改善收缩功能的心肌节段数与术后LVEDV呈线性显著正相关(r=0.61,P﹤0.05)。结论 LDDSE除评价存活心肌的数量外,还可评估、预测CRV术后心室的收缩功能,能够指导临床选择治疗方案,预测疗效和评估预后。     

Milrinone echocardiographic viability test: a pilot study.

We assessed the utility of milrinone to predict recovery of function after surgical myocardial revascularization in patients with severe baseline left ventricular systolic dysfunction caused by coronary artery disease (CAD). Prediction of viable myocardial segments that will regain function after revascularization may help in the selection of patients who will benefit from coronary artery bypass graft surgery (CABG) as well as aid in the choice of target sites for coronary revascularization. We investigated 20 consecutive patients with CAD and left ventricular ejection fraction < or = 40% who had evidence of myocardial viability by either thallium scan or dobutamine viability test and were candidates for elective CABG. Left ventricular regional wall motion and global ejection fraction were assessed by transesophageal echocardiography in the operating room. Measurements were done before and 10 minutes after milrinone infusion, and immediately after CABG. Left ventricular wall motion score was derived by means of a 12-segment model. Functional improvement for each segment was defined as a wall motion change > 1. Baseline ejection fraction was 27% +/- 5% (mean +/- SD). Ejection fraction increased to 35% +/- 5% after milrinone infusion (P < .0001) and to 36% +/- 6% after CABG (P < .0001). Post-CABG ejection fraction was significantly correlated with postmilrinone ejection fraction (r = 0.65, P < .0001). Milrinone infusion resulted in augmentation of contraction in 98 of the 209 abnormal segments (wall motion score > or = 2); 91 (92.9%) of these improved after CABG. One hundred nine of the 111 segments that showed no improvement with milrinone did not improve after revascularization (98.2%). Seventy-three segments were akinetic or dyskinetic at baseline; 46 (63.0%) of these improved with milrinone. Improvement in regional wall motion after revascularization was detected in 84.8% of the segments that improved with milrinone versus only 3.7% of the segments that did not improve with milrinone. In patients with ischemic cardiomyopathy, improvement in left ventricular function (segmental wall motion and global ejection fraction) during milrinone infusion is highly predictive of improvement after CABG.     

应变显像评价ST段抬高急性心肌梗死患者存活心肌的敏感性与特异性

目的 比较应变显像(SI)与静息-再分布201Tl心肌灌注显像(RR-201Tl-SPECT)预测ST段抬高的急性心肌梗死(AMI)患者存活心肌的敏感性与特异性.方法 对26例AMI患者进行介入治疗1周后行超声心动图和RR-201Tl-SPECT检查,并随访治疗≥3个月后的超声心动图.测量左室长轴16节段的应变及RR-201 Tl-SPECT心肌灌注评分,以1周和≥3个月的室壁运动评分(WMS)对比作为判定存活心肌的"金标准".结果 ①共研究260个缺血节段.随访(5±2)月,据WMS判定存活节段201个,梗死节段59个.RR-201 Tl-SPECT预测存活心肌的敏感性和特异性为87%(175/201)和58%(34/59).②以收缩期应变(Set)＜-6%为最佳截止点预测存活心肌的敏感性和特异性分别为81%(161/201)和66%(39/59).③Set与RR-201 Tl-SPECT总符合率77%(199/260),具有中等一致性(Kappa=0.40).结论 S1评价ST段抬高AMI患者的存活心肌是可行的,其与RR-201 Tl-SPECT显像诊断效力相似,是更简便、无创、低成本的替代选择.     

Detection of residual tissue viability within the infarct zone in patients with acute myocardial infarction: ultrasonic integrated backscatter analysis versus dobutamine stress echocardiography.

OBJECTIVES: The goals of this study were to analyze temporal changes in cardiac cyclic variation of integrated backscatter (CVIB) in acute myocardial infarction (AMI) and to investigate the predictive value of CVIB normalization compared with that of dobutamine stress echocardiography (DSE) in the assessment of functional recovery after revascularization. BACKGROUND: The normal CVIB is blunted by ischemia and recovers early after reperfusion, faster than wall motion improvement. Analysis of CVIB has been widely investigated for its potential to detect viable myocardium in the early stage of infarction. No studies have compared CVIB analysis with other techniques for viability assessment in patients with acute ischemic. Methods and Results: Integrated backscatter images were obtained in 12 patients with AMI on days 1, 3, and 7 after admission and 1 month after revascularization. On day 7, DSE was performed in all patients. On admission, 22 of 144 segments were dyssynergic. On day 1, CVIB was abnormal in all 22 infarcted segments, on day 3, in 16, and on day 7, in only 10 infarcted segments. Eight of 10 segments nonviable by CVIB (CVIB-nonviable) were also nonrespondent by DSE; whereas 12 of 14 segments viable by DSE (DSE-viable) were also CVIB-viable. At follow-up, 10 CVIB-viable segments and 1 CVIB-nonviable segment showed functional recovery; whereas 10 of 14 DSE-viable segments showed functional recovery. Thus the positive predictive value of CVIB and DSE was 83% and 72%, respectively, with a diagnostic agreement between techniques in 77% of segments. CONCLUSIONS: Our data suggest that the normalization in CVIB in the first week after AMI accurately predicts residual tissue viability within the infarct zone. We also observed that the initial pattern of cyclic variation may be predictive of functional recovery. Finally, we found a good correlation between the recovery of a normal CVIB in segments that were still dysfunctional and a more validated method to assess tissue viability, such as the dobutamine test.     

实时心肌声学造影与二维应变成像技术评价心肌梗死后患者心肌存活性

目的 探讨实时心肌声学造影与二维应变成像技术评价心肌梗死后患者存活心肌的价值.方法 20例准备进行血运重建术心肌梗死患者,于术前1周内行实时心肌造影检查,根据心肌灌注结果进行半定量评价:3分为充盈缺损,2分为回声稀疏不均匀及心内膜下充盈缺损,1分为回声均匀性增强;MCE定义心肌存活性为心肌灌注计分≤2分,而心肌充盈缺损表示无心肌存活性.血运重建术前及术后3个月分别获取心尖位四腔、两腔及左心长轴切面二维图象,进行室壁运动评分,根据术后的室壁运动有否改善分为存活心肌组和无存活心肌组,测定术前左室各节段心肌的收缩期纵向峰值应变.结果 (1) 血运重建术前,二维超声心动图发现共有90个室壁明显发生节段性运动异常,其中有70个室壁的节段性运动异常术后得到改善.(2)血运重建术前,实时心肌声学造影评价存活心肌为65节段,无存活心肌为25节段,敏感性、特异性及准确性分别为93.8%、64%和85.5%.(3) 存活心肌组术前心肌收缩期纵向峰值应变明显高于无存活心肌组[(-7.34±5.84)% vs (-2.11±1.66)%,P＜0.001].以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值判断心肌梗死时存活心肌的敏感性为72%,特异性为85%.结论 实时心肌声学造影可以准确地预测梗死心肌的存活性;同时二维应变成像技术以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值也可以预测梗死心肌的存活性,其敏感性和特异性与实时心肌声学造影相当.     

Assessment of no-reflow phenomenon after acute myocardial infarction with harmonic angiography and intravenous pump infusion with Levovist: comparison with intracoronary contrast injection.

Myocardial contrast echocardiography (intracoronary application) has emerged as an accurate method to detect the "no-reflow phenomenon." To investigate the diagnostic value of harmonic angiography after intravenous infusion of Levovist in assessing "no-reflow," both intracoronary and intravenous contrast injections were performed in a group of patients with acute myocardial infarction. Seventeen consecutive patients with a successfully reperfused acute myocardial infarction within 6 hours of symptom onset were selected for this study. All patients underwent contrast echocardiography with harmonic angiography with Levovist (400 mg/mL, intravenous pump infusion, trigger intervals 1:4 to 1:8) and sonicated albumin (0.5 to 1 mL, intracoronary bolus) on day 1 after the achievement of a sustained coronary reflow. Myocardial perfusion was qualitatively assessed with a 12-segment model. The endocardial length of the residual contrast defect after reflow was also calculated. Forty-four of 204 segments were not analyzed after intravenous contrast echocardiography and 37 after intracoronary contrast echocardiography because of artifacts. Intracoronary and intravenous injections showed a perfusion defect in 31 (19%) segments, with a concordance of 89% (kappa coefficient, 0.72). Concordance in anteroseptal, anterolateral, and inferolateral segments was 95% (kappa = 0.92), 88% (kappa = 0.66), and 83% (kappa = 0.57), respectively. With intracoronary injection used as the reference method, intravenous injection had a sensitivity of 74% and a specificity of 93% for diagnosing contrast defects. The endocardial extent of no-reflow was 18 +/- 19 after intravenous and 21 +/- 17 after intracoronary contrast echocardiography (P = not significant). Intravenous contrast echocardiography with Levovist reliably identifies the no-reflow phenomenon after successful reperfusion, especially in acute anteroseptal myocardial infarction.     

经静脉注射Levovist心肌声学造影间隙显像评价心梗患者心肌存活性：与心脏核素的对比研究

目的,本研究旨在评价经静脉注射Levovist心肌声学造影间隙显像检测心梗患者梗塞区心肌存活性的价值。方法：本研究对25例临床诊断为陈旧性心梗患者心肌声学造影和核素心肌显像的节段心肌灌注进行比较。结果：25例患者400个节段中,声学造影和^201铊记分完全一致的有271个节段（68％）,与核素相关1级的有122个节段（30％）,相差2级的有7个节段（2％）,Kappa=0.538,心肌声学造影判断存活心肌与心脏核素的符合率为81％,Kappa=0.521,敏感性和特异性分别为90％和60％。阳性预测值,阴性预测值分别为84％和72％,结论：经静脉注射Levovist心肌声学造影检测心梗患者梗塞区心肌存活性能提供与心脏核素相似的信息,但在左室心尖部和前间壁的显示仍有待进一步提高。