实时心肌声学造影的仪器设置与显像效果的影响因素

目的：探讨实时心肌声学造影的仪器设置及显像效果的影响因素。方法：8只开胸充微量注射泵静脉滴注氟碳类造影剂全氟显（速度为5ml/min和10ml/min)进行实时心肌声学造影。调节仪器设置如增益,量程及深度等参数,于左室乳头肌水平短轴切面观察心肌显影的不同效果。结果：实时心肌声学造影可同时显示心肌血流灌注和室壁运动,除降低接受增益至50％,使用默认的仪器设置即可获得良好的造影效果,闪烁显像时最佳闪烁帧数为5个。结论：实时心肌声学造影易于掌握,影响因素较少,可同时观察心肌灌注和室壁运动,闪烁显像具有定量评价心肌血流灌注的潜力。     

心肌声学造影最新进展—实时心肌声学造影

由于常规超声心动图的声功率水平会破坏造影剂微泡 ,近年来心肌声学造影 (MCE)均使用触发显像技术。触发显像改善了心肌显影的效果 ,但实际操作中技术难度较大 ,检查者需长时间维持切面稳定 ,另外不同的造影剂种类、剂量、注入方式和速度 ,往往难以确定适合的触发间期。更重要的是触发显像无法显示室壁运动 ,而室壁运动异常是常规及负荷超声心动图确定心肌缺血诊断冠心病的基础。再者使用触发显像容易出现后壁、侧壁与后间隔的衰减 ,造成假性充盈缺损的现象。以上因素均限制了 MCE的应用价值。1999年 Porter等 [1 ]报道通过降低机械指数…     

心肌声学造影研究进展

随着新型造影剂和显影技术出现，MCE的图像质量得到很大提高，目前已开始应用于临床。近年来，国内外的研究表明，MCE可能具有下列潜在的临床应用价值：     

心肌声学造影进展

心肌声学造影进展北京邮电医院徐南图，张汉京冠脉造影能提供冠脉狭窄部位、程度以及侧支血管情况，是一个诊断冠心病不可缺少的经典方法。尽管在大多情况下，冠脉狭窄程度和相应区域心肌灌注状态呈一致关系，但有时冠脉正常，或并无有意义的狭窄，局部心肌却存在灌注不良...     

心肌声学造影研究进展

一、声学造影剂的研制进展196 8年Ｇｒａｍｉｋ等将用手振动后的靛青蓝绿注入犬心腔后 ,在二维超声心动图上发现心腔内产生云雾状回声增强 ,以后证明云雾影的产生与注射液中经振荡混入的微气泡有关 ,由此揭开了心脏声学造影的序幕。早年使用的声学造影剂微泡较大 ,均一性不佳 ,难以通过肺循环 ,主要用于右心系统 (右房、右室 )显像。 1984年 ,Ｆｅｉｎｓｔｅｉｎ首次报道了采用超声振动 (声振 ,ｓｏｎｉｃａｔｉｏｎ)法制备声学造影剂 ,所得造影剂微泡直径小于红细胞 ,且浓度明显高于手振法 ,经静脉注射后可以顺利通过肺循环实现左心系统声…     

心肌声学造影研究进展

1968年Gramiakt等首次用生理盐水与靛青绿混合振荡液，经心导管注射，用超声心动图观察，实现了右心腔显影，开创了心脏声学造影的先河。早期的声学造影剂(如二氧化碳及双氧水)由于微泡稳定性差、直径较大，经静脉注射后微泡造影剂不能通过肺循环进入左心腔实现心肌组织显影，故其临床应用一直局限在用于心腔显影以了解心内结构有无异常及分流、反流     

经皮激光心肌打孔术中左心室造影定位方法学探讨

目的探索经皮激光心肌打孔血运重建术（ＰＭＲ）中左心室造影定位方法。方法应用不同的记录模式对１２例行ＰＭＲ治疗的病患者进行左心造影打孔区定位检查。结果１２例冠心病患者ＰＭＲ治疗均获成功,无任何并发症发生。结论①左心室造影中６例应用ＣＳＰ模式记录,６例应用ＤＣＩ＋ＭＡＰ模式记录,均可记录到满意的左心室双期图像。②ＰＭＲ术中利用左心室腔轮廓和骨性结构标志进行定位时,ＤＣＩ＋ＭＡＰ模式优于ＣＳＰ模式。③每次造影以造影剂总量３５ｍｌ、速度１２～１７ｍｌ／ｓ、压力７５０ＰＳＩ为宜。造影剂,最好选用非离子型。④选择高压注射器的Ｒ波触发造影,可减少造影过程中心律失常的发生,提高造影的成功率。⑤投照角度固定应用双斜位,右前斜位３０度,左前斜位６０度,可便于手术前后对比及影像的计算机后处理     

心肌声学造影的现状和展望

冠脉造影是一个解剖学检查法,而不是一个生理功能性检查法。冠脉狭窄和相应灌注区心肌缺血程度之间并非呈绝对平行关系。为此,心肌灌注功能测定这一检查方法受到临床极大重视。八十年代初以来兴起了二维超声心动图心肌声学造影的研     

心肌声学造影的应用

心肌声学造影的应用赵博文综述王新房审校心肌声学造影（ｍｙｃｏａｒｄｉａｌｃｏｎｔｒａｓｔｅｃｈｏｃａｒｄｉｏｇｒａｐｈｙ；ＭＣＥ）或称心肌造影超声心动图是通过注射含有微气泡的声学造影剂，用超声心动图来研究心肌灌注状态的一种新技术。国外愈来愈多地将其用...     

心肌声学造影的现状

1984年Feinstein等首次报道微泡直径与红细胞相似的声振造影剂静注法可以通过肺循环,达到左心和心肌声学造影的效果。从此,心脏声学造影进入了一个崭新的阶段。冠脉狭窄的程度和相应部位心肌的实际灌注状态并不呈一致性关系:有时冠脉造影正常或仅有无意义的狭窄,而却被证?..     

Myocardial contrast echocardiography predicts left ventricular remodelling after acute myocardial infarction.

BACKGROUND: We investigated whether the extent of residual myocardial viability demonstrated by myocardial contrast echocardiography (MCE) predicts the degree of left ventricular (LV) remodelling after acute myocardial infarction as assessed by cardiovascular magnetic resonance. METHODS: Accordingly, 25 patients underwent MCE 5 to 7 days after acute myocardial infarction followed by cardiovascular magnetic resonance assessment of LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction. A contrast perfusion index was calculated within the infarct-related territory. RESULTS: LV end-diastolic and end-systolic volumes were significantly smaller (138 +/- 38 vs 188 +/- 43 mL, P =.008, and 86 +/- 35 vs 119 +/- 49 mL, P =.01, respectively) and LV ejection fraction was significantly higher (52 +/- 5.4 vs 31.5 +/- 3.2%, P> =.02) in patients showing good myocardial viability (contrast perfusion index 相似文献   

Intravenous myocardial contrast echocardiography predicts left ventricular remodeling in patients with acute myocardial infarction.

BACKGROUND: This study evaluated the ability of intravenous myocardial contrast echocardiography (MCE) performed in the setting of acute myocardial infarction for prediction of left ventricular (LV) remodeling. METHODS: Intravenous MCE was performed immediately before, 1 hour, and 24 hours after primary percutaneous transluminal coronary angioplasty (PTCA) in 35 patients with a first myocardial infarction. The MCE was used to define the relative perfusion defect size (in %; relMCD). Two-dimensional echocardiography was performed directly after angioplasty and after 4 weeks to determine LV end-diastolic volumes (LVEDV). The increase in LVEDV at 4 weeks defined a remodeling (> 15% increase) and a nonremodeling group (< or = 15% increase). RESULTS: Patients with remodeling had larger relMCD before (22.0 +/- 16.1 vs 8.0 +/- 11.9, P =.015), 1 hour (20.0 +/- 13.0 vs 4.9 +/- 11.6, P =.001), and 24 hours after PTCA (22.9 +/- 14.1 vs 1.2 +/- 2.8, P <.001). There was a significant correlation between relMCD 24 hours after PTCA and the increase in LVEDV at 4 weeks (r = 0.648; P <.001). Receiver operating characteristic (ROC) curve analysis revealed a relMCD at 24 hours of 5.1% or more to predict remodeling with a sensitivity of 94% and a specificity of 87% (area under ROC curve = 0.917; SE = 0.054). Multivariate analysis demonstrated relMCD at 24 hours to be the only predictor of remodeling (odds ratio = 173.4; P =.022). CONCLUSION: The size of the persistent MCE perfusion defect after revascularization for acute myocardial infarction has a high predictive value for LV remodeling during a 4-week follow-up period.     

Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography.

In addition to a thrombus, an intracardiac mass lesion can represent a primary cardiac tumor, or a metastatic lesion to the heart. The echocardiographic appearance and location of the mass, as well as the associated clinical scenario provide useful clues regarding cause, but these echocardiographic features alone may not always be diagnostic. Because most benign cardiac tumors are relatively avascular, the vascularity of a mass may be a feature that can help differentiate benign from malignant tumors. We present a case of a patient with a history of malignant melanoma who was found incidentally to have a cardiac mass on echocardiography. Contrast echocardiography (CE) was used to evaluate the vascularity of the mass. This case is compared with another patient with an apical thrombus, which represents an "avascular" intracardiac structure.     

左心室超声造影诊断左室心肌致密化不全的应用价值

目的 探讨左室超声造影在诊断左室心肌致密化不全中的应用价值.方法 对10例经胸超声心动图初步诊断和疑似的心肌致密化不全患者进行左室超声造影检查,进一步观察左室内过度增生的肌小梁的范围、心内膜连续性、致密心肌厚度及造影剂在小梁隐窝内充盈情况.结果 左室超声造影可更加清晰地观察到非致密心肌的范围,造影剂在小梁间隙和隐窝内充盈,超声造影对致密心肌厚度的测量更为精确、客观.结论 左室超声造影可用于诊断左室心肌致密化不全,是对常规经胸超声心动图的良好补充.     

左心室超声造影诊断左室心肌致密化不全的应用价值

目的 探讨左室超声造影在诊断左室心肌致密化不全中的应用价值.方法 对10例经胸超声心动图初步诊断和疑似的心肌致密化不全患者进行左室超声造影检查,进一步观察左室内过度增生的肌小梁的范围、心内膜连续性、致密心肌厚度及造影剂在小梁隐窝内充盈情况.结果 左室超声造影可更加清晰地观察到非致密心肌的范围,造影剂在小梁间隙和隐窝内充盈,超声造影对致密心肌厚度的测量更为精确、客观.结论 左室超声造影可用于诊断左室心肌致密化不全,是对常规经胸超声心动图的良好补充.

Abstract：

Objective To assess the usefulness of left ventricular contrast echocardiography in diagnosis of left ventricular myocardium noncompaction.Methods Contrast echocardiography was done in ten patients who were diagnosed or suspected with left ventricular noncompaction by common transthoracic echocardiography,for further study of the trabecular muscles extent,the continuity of the endocardium,the compact myocardium thickness,and the contrast agent in the trabecula recessus.Results By contrast echocardiography,noncompaction myocardium thickness can be perspicuously observed,the turgor of the contrast agent was vividly detected in the trabecular recessus.Especially for the measurement of compaction myocardium,the contrast echocardiography was more accurate than in the condition of the common echocardiography.Conclusions Left ventricular contrast echocardiography can be used in the diagnosis of left ventricular noncompaction,it was a good added method of conventional echocardiography.     

Quantitative assessment of left ventricular perfusion defects using real-time three-dimensional myocardial contrast echocardiography.

Quantitative assessment of perfusion defects with myocardial contrast echocardiography can be a valuable tool in the evaluation of patients with coronary artery disease. However, the use of 2-dimensional echocardiography for this purpose is limited to a restricted number of imaging planes. Real-time 3-dimensional echocardiography (RT3D) is a novel technique that provides instantaneous volumetric images. The aim of this study was to validate the use of RT3D for the quantitative assessment of myocardial perfusion defects in a model of acute coronary occlusion. To this end, 20 sheep underwent acute ligation of the left anterior descending (n = 14) or the posterior branch of the circumflex (n = 6) artery under general anesthesia. The RT3D images were obtained after left atrial injection of the contrast agent EchoGen (perflenapent emulsion; 0.8-1 mL). Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. The mass of the entire left ventricle and of the underperfused myocardial region were measured after death. Blinded off-line calculation of left ventricular (LV) mass and perfusion-defect mass from RT3D images were performed using an interactive aided-manual tracing technique. Total LV mass ranged from 68 to 141 g (mean plus minus SD: 92 +/- 24 g). The mass of the perfusion defect ranged from 0 to 43 g (mean +/- SD: 16 +/- 9 g) or 0 to 36% of total LV mass (mean +/- SD: 18% +/- 9%). The RT3D estimation of total LV mass strongly correlated with the anatomic measurement (r = 0.91; y = -2.54 + 1.04x; standard error of the estimate [SEE] = 11.9 g). The RT3D calculation of the mass of underperfused myocardium also strongly correlated with the anatomic measurement, both in absolute terms (r = 0.96; y = 2.01 + 0.87x; SEE = 2.2 g) and when expressed as percentage of total LV mass (r = 0.96; y = 0.11 + 1.02x; SEE = 2.8%). Hence, RT3D with myocardial contrast opacification accurately predicts the amount of underperfused myocardium in an animal model of acute coronary occlusion. This technique may therefore be useful for the quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.     

Value of myocardial contrast echocardiography for predicting left ventricular remodeling and segmental functional recovery after anterior wall acute myocardial infarction.

OBJECTIVE: We sought to study the value of microvascular perfusion assessed by myocardial contrast echocardiography in predicting left ventricular remodeling after anterior wall acute myocardial infarction. METHODS: In 31 patients myocardial contrast echocardiography was performed up to 48 hours after acute myocardial infarction with determination of end-diastolic and end-systolic volumes, wall-motion score index, and myocardial perfusion score index (MPSI) at rest and under dobutamine stress at 6 months. Patients were classified into remodeling group (RG) (n = 19) and non-RG (n = 12), and, according to number of segments without opacification, reflow (< or =2 segments, n = 15) and no-reflow (>2 segments, n = 16) groups. RESULTS: Wall-motion score index (1.84 +/- 0.22 vs 1.64 +/- 0.3; P =.049), MPSI (1.53 +/- 0.25 vs 1.26 +/- 0.17; P =.006), and number of segments without contrast (3.11 +/- 2.23 vs 1.08 +/- 1.38; P =.018) were higher in RG than in non-RG. End-diastolic and end-systolic volumes, and wall-motion score index, increased significantly in RG at 6 months and decreased in non-RG. MPSI increased in RG (1.53 +/- 0.25-1.66 +/- 0.21; P =.011) and was the only independent predictor of left ventricular remodeling (odds ratio = 1.8; 95% confidence interval = 1.15-2.82; P =.010). No-reflow group presented 27.8 +/- 19.9% of segments with resting functional recovery or contractile reserve, and reflow group presented 69.9 +/- 31.2% (P <.001). CONCLUSION: MPSI obtained 48 hours after acute myocardial infarction is an independent predictor of left ventricular remodeling. Patients with two or fewer segments without opacification revealed a better prognosis of resting ventricular function and contractile reserve.     

超声造影检测心肌梗死患者受损左室壁的价值

目的探讨超声造影在检测心肌梗死患者左室壁受损范围中的价值。方法对75名发生心肌梗死的患者进行实时心肌造影,分别于超声造影前后观察心内膜边界显示情况,评价和比较节段室壁运动情况。结果超声造影后左室心内膜边界的显示较造影前明显清晰,受损节段与未受损节段的对比增强。以冠状动脉造影结果为标准,造影检测的灵敏度、特异度和准确度均高于造影前（p〈0．05）。结论实时超声造影能有效增强左室心内膜边界显示和受损心肌边界显影,提高对左室壁受损范围检测的准确性。     

实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构

目的探讨实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构的价值。方法20例准备行血运重建术心肌梗死患者,于术前1～5d行常规超声心动图和实时心肌造影超声心动图检查,并于术后3个月再行常规超声心动图检查。室壁运动分析采用18节段分析法,心肌造影灌注分析：按照心肌灌注记分指数（MPSI）分成2组：MPSI≤1．5为心肌灌注良好组;MPSI〉1．5为心肌灌注较差组。分别将：①两组术前左室射血分数（LVEF）、左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）与术后3个月比较;②两组术前的LVEF、LVESV、LVEDV,术后3个月的LVEF、LVESV、LVEDV各自比较;③两组患者手术前后左室射血分数差值（ALVEF）、收缩末容积差值（ALVESV）、舒张末容积差值（△LVEDV）进行比较;④对ALVEF、△LVESV、△LVEDV与MPSI分别做相关性分析。结果MPSI〉1．5组患者手术后3个月的LVEF较MPSI≤1．5组明显减低,LVEDV较MPSI≤1．5组明显增大,MPSI〉1．5组和MPSI≤1．5组患者的ALVEF、ALVEDV存在差别,差异有统计学意义（P〈0．05）;MPSI与ALVEF呈负相关,与△LVESV、△LVEDV呈正相关（P〈0．05）。结论术前MPSI〉1．5组较MPSI≤1．5组发生左室重构的可能性大,实时心肌超影超声心动图能较好的评估心肌梗死患者血运重建术后左室重构情况。