经静脉心肌声学造影评价心肌梗死后存活心肌的价值

目的　探讨经静脉心肌声学造影 (MCE)对心肌梗死后存活心肌的诊断价值。方法　 2 4例心肌梗死患者用二维超声评价室壁运动情况 ,同时经静脉进行MCE ,以 3个月后静态超声心动图左室心肌节段性运动改善为依据评价MCE对心肌梗死后存活心肌的诊断价值。结果　在 2 4例病人的 384个心肌节段中 ,运动异常节段 184个。在运动异常的 184个节段中 ,MCE1分 39段 ,0 5分 5 0段 ,0分 95段。 3个月复查 79个节段有运动改善 ,其中 39段来自MCE1分的心肌 ,4 0段来自MCE0 5分的心肌。MCE对预测心肌梗死后室壁运动改善的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 :10 0 %、89 7%、84 8%、10 0 %和 94 6 %。结论　MCE能比较准确地预测心肌梗死后心肌的存活性     

Identification of viable myocardium by perfusion imaging with intravenous contrast echocardiography after acute myocardial infarction

Myocardial perfusion contrast echocardiography is evolving into an effective method for the evaluation of myocardial blood flow after acute coronary events. The direct injection of ultrasound contrast agents into the aortic and coronary circulation has been shown to accurately identify areas of viable myocardial tissue. Recently, intravenous ultrasound contrast has been found to be useful in detecting microvascular blood flow after the restoration of blood flow in patients with myocardial infarction. We present the case of a patient in whom intravenous ultrasound contrast assisted in the detection of viable myocardial tissue after an acute ischemic syndrome.     

Usefulness of myocardial contrast echocardiography early after acute myocardial infarction

OBJECTIVES: (1) Evaluate wall motion and perfusion abnormalities after reperfusion therapy of the culprit lesion, (2) delineate the ability of myocardial contrast echocardiography (MCE) to evaluate the microvasculature after reperfusion, in order to distinguish between stunning and necrosis in the risk area. METHODS: We analyzed 446 segments from 28 patients, 10 normal controls (160 segments), and 18 with a first AMI (286 segments). MCE was obtained with Optison and a two-dimensional echocardiography was performed at 3 months post acute myocardial infarction (AMI). RESULTS: In the group with AMI, we analyzed 286 segments, of which 107 had wall motion abnormalities (WMA) related to the culprit artery. Two subgroups were identified: Group I with WMA and normal perfusion (50 segments, 47%) and Group II with WMA and perfusion defects (57 segments, 53%). According to the 2D echocardiogram at 3 months, they were further subdivided into: Group IA: with wall motion improvement (stunning): 18 segments, 36%, Group IB: without wall motion improvement: 32 segments, 64%, Group IIA: with wall motion improvement: 12 segments, 21%, Group IIB: without wall motion improvement (necrosis): 45 segments, 79%. CONCLUSIONS: (1) The presence of myocardial perfusion in segments with WMA immediately after AMI reperfusion therapy predicts viability in most patients. Conversely, the lack of perfusion is not an absolute indicator of the presence of necrosis. (2) Perfusion defects allow to detect patients with thrombolysis in myocardial infarction (TIMI) 3 flow and "no-reflow" phenomenon who will not show improved wall motion in the 2D echocardiogram. However, some patients with initial no-reflow could have microvascular stunning and their regional contractile function will normalize after a recovery period.     

Combined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction

BACKGROUND: Myocardial contrast echocardiography and dobutamine echocardiographyhave recently emerged as potentially useful clinical tools todetect reversible myocardial dysfunction. However, the relativeaccuracy of these two techniques in predicting regional wallmotion improvement after coronary interventions is still unclear.The aim of the present study was to compare their diagnosticvalue in predicting functional recovery after coronary revascularizationin patients with recent acute myocardial infarction. METHODS AND RESULTS: Twenty-four patients with acute myocardial infarction underwentmyocardial contrast echocardiography and dobutamine echocardiographywithin 2 weeks of hospital admission. Infarct zone contrastscore and wall motion score indexes were derived in each patient.Infarct-related artery revascularization was performed beforehospital discharge in all selected patients. Resting echocardiographywas repeated 3 months after revascularization, and regionalfunction recovery was analysed. The degree of wall motion scoreimprovement at 3-month follow-up and the percentage of positiveresponses to dobutamine echo were greater (P<0·001and P<0·002, respectively) in patients with a higherbaseline contrast score (0·50). Conversely, no significantchanges were observed either during dobutamine echo or afterrevascularization in the group of patients without residualperfusion within the infarct area. Diagnostic agreement betweenboth techniques in predicting reversible dysfunction was high(81% of segments). The sensitivity and negative predictive valuein predicting functional outcome were 100% (95% confidence interval[CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrastecho, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%)by dobutamine echo. The specificity and positive predictivevalue were 90% (95% CI, 80% to 96%) and 81% (95% CI, 64% to93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76%(95% CI, 58% to 90%) by dobutamine echo. The combination ofmyocardial contrast and dobutamine echocardiography positiveresponses improved specificity and positive predictive valuein detecting functional recovery after revascularization to100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively.However, the sensitivity and negative predictive value slightlydecreased with the use of both methods (85% [95% CI, 66% to96%)] and (93% [95% CI, 85% to 98%)], respectively. CONCLUSIONS: In patients with recent myocardial infarction, reversible dysfunctionafter coronary revascularization and the response to dobutamineinfusion are strictly dependent on microvascular integrity.However, microvascular perfusion does not always imply functionalrecovery after coronary revascularization. The integration withdob utamine echo results seems particularly helpful to furtherimprove myocardial contrast echo specificity and positive predictivevalues.     

Myocardial contrast echocardiography in acute myocardial infarction: Pathophysiological background and clinical applications

Myocardial contrast echocardiography is a technique used inexperimental and clinical settings in order to visualize thepattern of intramyocardial perfusion. In the acute phase ofmyocardial infarction, regional absence of flow during myocardialcontrast echocardiography delineates the area at risk of necrosis,while the definitive non-perfused area expresses infarct size.Reopening the infarct-related artery, which may be achievedspontaneously by thrombolysis or percutaneous transluminal coronaryangioplasty, is not a reliable indicator of intramyocardialreperfusion. If myocardial ischaemia due to coronary occlusionhas been sufficiently prolonged and severe, not only myocyteviability, but also microvascular integrity is lost. Myocardialcontrast echocardiography, using intracoronary injection ofsonicated contrast medium, gives information about microvascularintegrity and the effective presence of intramyocardial reflow.Anatomical integrity of microvasculature does not necessarilyimply preserved function, and thus the microvessel vasodilatingreserve may also be impaired. Myocardial contrast echocardiographyhas the potential to assess alterations in microvascular function,showing, in the myocardial area with reduced coronary reserve,a relatively reduced increase in echocontrast signal intensitywhen an intravenous vasodilator agent is administered. (Eur Heart J 1996; 17: 344–353)     

小剂量多巴酚丁胺超声心动图联合心肌声学造影对心肌梗死后存活心肌的诊断价值

目的前瞻性评价小剂量多巴酚丁胺超声心动图(LDDE)联合心肌声学造影(MCE)对心肌梗死后存活心肌的诊断价值。方法对24例心肌梗死者进行静态MCE、LDDE及3个月后静态超声心动图随访分析。MCE和室壁运动均用16段划分法进行目测半定量计分。心肌造影计分(MCS)回声均匀性增强为1分,回声低淡不均匀为0.5分,缺损为0分。室壁运动计分(WMS)用常规计分法。结果随访时,运动改善的心肌节段中MCS1分占49.4%、0.5分占50.6%,对LDDE均有反应;运动无改善的节段MCS0.5分占9.5%,0分占90.5%,对LDDE有反应者占13.3%,无反应占86.7%。预测存活心肌的敏感性、特异性及准确率分别为LDDE86%、86.7%、86.4%;MCE100%、89.7%、94.6%;LDDE联合MCE86.1%、100%、94.0%。结论心肌微血管结构与功能的完善是心肌存活的基本条件。MCE灌注正常和低灌注,且对多巴酚丁胺有反应的心肌有收缩力储备;而对多巴酚丁胺无反应的低灌注或无灌注心肌则多不能恢复收缩功能。LDDE联合MCE能提高检测存活心肌的特异性及准确率。     

Usefulness of quantitative intravenous myocardial contrast echocardiography to analyze microvasculature perfusion in patients with a recent myocardial infarction and an open infarct-related artery: comparison with intracoronary myocardial contrast echocardiography.

AIMS: We analyzed the usefulness of quantitative intravenous myocardial contrast echocardiography to study microvasculature perfusion after infarction in comparison with intracoronary myocardial contrast echocardiography. METHODS AND RESULTS: Thirty-two patients with a first ST elevation myocardial infarction, single-vessel disease and an open artery (TIMI 3) were studied before discharge. Myocardial perfusion in the risk area was quantified with intracoronary and intravenous myocardial contrast echocardiography. Perfusion was normal (intracoronary contrast echocardiography normalized videointensity >0.75) in 78 out of 97 dysfunctional segments (80%). Sensitivity and specificity of intravenous contrast echocardiography to predict normal perfusion were 87% and 63% for 'first-pass myocardial blood flow' (upslope of contrast arrival x peak intensity after intravenous bolus injection of contrast) and 91% and 89% for end-systolic single-triggered images captured every 6 cycles, respectively. In an analysis per patients, normal perfusion (0 or 1 hypoperfused segments with intracoronary contrast echocardiography) was observed in 22 cases (69%). End-systolic single-triggered images showed a strong correlation with intracoronary contrast echocardiography (R2 = 0.82, p = 0.0001). CONCLUSIONS: Intravenous contrast echocardiography is a useful technique to analyze microvasculature perfusion soon after infarction. A quantitative analysis of single-triggered images is an easy-to-obtain and reliable method to define perfusion when compared with intracoronary contrast echocardiography.     

Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty

BACKGROUND:

Angiographic flow in an epicardial artery does not define perfusion at the microvascular level.

AIM:

To compare myocardial contrast echocardiography (MCE) with angiographic methods of assessing microvascular reperfusion in patients with acute myocardial infarction (AMI).

METHODS:

One hundred consecutive patients with a first ST segment elevation myocardial infarction and single-vessel disease were successfully treated with primary percutaneous coronary intervention. Regional contrast score index (RCSI), corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and myocardial blush grade were evaluated.

RESULTS:

Among 717 asynergic segments on MCE, 168 revealed a lack of perfusion. TMPG and cTFC correlated significantly with RCSI (P=0.031 and P=0.027, respectively). Myocardial blush grade did not correlate with RCSI (P=0.067). Patients with anterior AMI had significantly more segments with a perfusion defect on MCE than patients with inferior AMI (P=0.0001).

CONCLUSIONS:

MCE results correlate with angiographic methods of perfusion assessment such as TMPG and cTFC. Anterior AMI is associated with a greater extent of perfusion defect. MCE results correlate also with recovery of systolic left ventricular function and clinical outcome at six month follow-up.     

Detection of functional recovery using low-dose dobutamine and myocardial contrast echocardiography after acute myocardial infarction treated with successful thrombolytic therapy

OBJECTIVE: We studied the value of low-dose dobutamine stress echocardiography (LDDE) and myocardial contrast echocardiography (MCE) in early prediction of left ventricular functional recovery (LVFR) after acute myocardial infarction (AMI) treated with successful thrombolysis. DESIGN: LDDE and MCE using second-harmonic intermittent imaging were performed in first week after AMI. LVFR was defined as an absolute > or =5% increase in ejection fraction, from early to 6 months of follow-up by Technetium-99m-Sestamibi single-photon emission computed tomography. PATIENTS: Out of 50 patients studied, 19 evolved with LVFR (group 1) and 31 without LVFR (group 2). Regional dysfunction was detected in 103 (37%) infarcted-related segments in group 1 and in 173 (63%) segments in group 2. RESULTS: Sensitivity, specificity, positive, and negative predictive values and accuracy for detecting LVFR by LDDE were 94.7% (18/19), 87.1% (27/31), 81.8% (18/22), 96.4% (27/28), and 90% (45/50), respectively, and by MCE were 94.7% (18/19), 51.6% (16/31), 54.5% (18/33), 94.1% (16/17), and 68% (34/50). In group 1, functional improvement was observed in 86.9% (53/61) of segments with contractile reserve by LDDE and in 65.8% (52/79) of segments with microvascular perfusion by MCE. In group 2, functional improvement was observed in 78.3% (18/23) of segments with contractile reserve by LDDE and in 25.5% (25/98) of segments with microvascular perfusion by MCE. All segments without perfusion by MCE evolved without functional recovery. CONCLUSION: LDDE was an accurate predictor of late left ventricular function recovery after AMI, while MCE was sensitive and has a high negative predictive value demonstrating that microvascular perfusion is essential for LVFR.     

Assessment of myocardial viability using myocardial contrast echocardiography

Myocardial contrast echocardiography (MCE) is a technique that uses microbubbles as a tracer during simultaneous ultrasound of the heart. The microbubbles can be used to provide quantitative information regarding the adequacy of myocardial blood flow (MBF), as well as the spatial extent of microvascular integrity. In acute myocardial infarction, MCE can identify the presence of collateral flow within the risk area, and can therefore predict preservation of myocardial viability and ultimate infarct size even prior to reperfusion. After reperfusion, the extent of microvascular no-reflow can be determined, and has significant implications for recovery of left ventricular function. In chronic ischemic heart disease, MCE has also been shown to successfully differentiate viable from necrotic myocardium. This technique can accurately predict recovery of function after revascularization. More importantly, MCE can be used to identify viable segments that may help to prevent infarct expansion and remodeling, and thus improve patient outcomes.     

Detection of resting myocardial perfusion defects by SonoVue myocardial contrast echocardiography

BACKGROUND: SonoVue is a new microbubble contrast agent containing sulfur hexafluoride. We assessed the efficacy of SonoVue myocardial contrast echocardiography (MCE) to detect resting perfusion abnormalities. Methods: Nineteen adult patients with a wall motion abnormality in a screening echocardiogram were studied. Each patient received up to four bolus injections of 2.0 mL SonoVue (Bracco Diagnostics, Inc.) during echocardiographic examination using either B-mode(n = 12)or power Doppler(n = 7)imaging. Each patient also had SPECT nuclear perfusion imaging performed. Segmental assessment of myocardial perfusion from SonoVue MCE images were compared with corresponding SPECT nuclear images. RESULTS: Using B-mode imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.4 to 1.9, with 2 or 3 injections required for a complete examination. Ninety-four percent of segments were scored as diagnostic. Agreement between B-mode and SPECT images was 72% for segments with a perfusion defect, 86% for normal perfusion, and 80% for segments with either perfusion defect or normal perfusion (all views combined). Using power Doppler imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.0 to 1.3, with 2 to 4 injections required for a complete examination. Sixty-eight percent of segments were scored as diagnostic. Agreement between power Doppler and SPECT images was 67% for perfusion defects, 53% for segments with normal perfusion, and 59% for segments with either perfusion defect or normal perfusion (all views combined). CONCLUSIONS: SonoVue MCE has the potential to assess myocardial perfusion at rest. B-mode imaging was more accurate than power Doppler imaging when compared with SPECT nuclear imaging.     

Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction.

AIMS: Early statin treatment has beneficial effects on prognosis after acute coronary syndrome. The no-reflow phenomenon determines the prognosis after acute myocardial infarction. We investigated the effects of statin treatment before admission on the development of the no-reflow after infarction. METHODS AND RESULTS: We performed intracoronary myocardial contrast echocardiography in 293 consecutive patients with acute myocardial infarction undergoing successful primary percutaneous coronary intervention. There were no significant differences in the incidence of the no-reflow between the patients with and without hypercholesterolaemia. The 33 patients receiving chronic statin treatment before admission had lower incidence of the no-reflow than those without it (9.1 and 34.6%, P=0.003). They also showed better wall motion, smaller left ventricular dimensions, and better ejection fraction at 4.9+/-2.2 months later. Multivariable logistic regression analysis revealed that statin pre-treatment was a significant predictor of the no-reflow along with anterior wall infarction, ejection fraction on admission, and additional ST-elevation after reperfusion, whereas total cholesterol was not. CONCLUSION: Chronic pre-treatment with statins could preserve the microvascular integrity after acute myocardial infarction independent of lipid lowering, leading to better functional recovery.     

Real time contrast echocardiography--a new bedside technique to predict contractile reserve early after acute myocardial infarction.

AIMS: Power pulse inversion echocardiography is a new technique by which contrast microbubbles can be visualised in real time within the myocardium, enabling simultaneous assessment of myocardial function and microvascular integrity, which is a prerequisite for myocardial viability. We aimed to determine whether microvascular integrity using power pulse inversion can be used to predict contractile reserve early after myocardial infarction. METHODS AND RESULTS: We studied 19 stable patients 5.1(1.6) days after presentation using low dose dobutamine stress echocardiography and power pulse inversion using slow bolus intravenous injections of Optison. A 16-segment left ventricular model was used to define wall thickening at baseline and following low dose dobutamine infusion (1, normal; 2, reduced; 3, absent), and contrast opacification (1, homogeneous; 2, heterogenous or reduced; 3, absent). The techniques were compared on a segment-by-segment basis to determine whether microvascular integrity (contrast opacification score of 1 or 2) could predict contractile reserve (any improvement during low dose dobutamine infusion) in segments that were akinetic at rest. Follow-up echocardiography was performed one month later. RESULTS: Ninety-four (31%) of the 304 segments were akinetic at rest, and 22 (23%) of these demonstrated contractile reserve. In 87 (92%) of the resting akinetic segments contrast opacification could be adequately determined, and of these 20 (23%) showed microvascular integrity. The negative and positive predictive value of microvascular integrity for determining contractile reserve was 90% and 65%, respectively, and 92% and 59% respectively for predicting recovery of function. CONCLUSION: Power pulse inversion can be used at rest to determine myocardial function and simultaneously to predict contractile reserve of akinetic segments in patients early after myocardial infarction. This technique has the potential to provide a bedside assessment of myocardial viability.     

Intraoperative assessment of myocardial perfusion using contrast echocardiography

Myocardial contrast echocardiography is a new technique capable of assessing regional myocardial perfusion in vivo in real time. This article reviews the background, principles, experimental validation, and clinical uses of intraoperative myocardial contrast echocardiography. Data can be derived both for online visual and computer analyses. The technique can be useful in determining the sequence of bypass graft placement and the success of graft anastamoses. Anastamoses can be revised immediately if needed. It is hoped that this technique will improve intraoperative myocardial preservation and will diminish the rate of perioperative myocardial infarction.     

Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time?

Acute myocardial infarction (AMI) continues to be a significant public health problem in industrialized countries and an increasingly significant problem in developing countries. ST elevation myocardial infarctions (STEMI) constitute approximately 40% of all AMIs with approximately 670,000 cases yearly in the United States alone. The risk of further cardiac complications such as re-infarction, sudden death, and heart failure for those who survive AMI is substantial. Thus, early assessment and risk stratification during the acute phase of STEMI is important. Furthermore, it is essential to assess the efficacy early after any initial therapeutic intervention, not only to facilitate further management, but also to enable development of new treatment algorithms/approaches to further improve the outcome. The aim of reperfusion therapy in AMI is not only to rapidly restore epicardial coronary blood flow but also to restore perfusion at the microcirculatory level. Myocardial contrast echocardiography (MCE) which utilizes microbubbles can assess myocardial perfusion in real time. Its ability to assess myocardial perfusion and function in one examination allows it to ascertain the extent of myocardial reperfusion achieved in the risk area. Furthermore, in stable patients after AMI, MCE allows assessment of LV function, residual myocardial viability, and ischaemia which are all powerful prognostic markers of outcome. Its portability, rapid acquisition and interpretation of data, and the absence of radiation exposure make it an ideal bedside technique.     

Functional role of microvascular integrity in patients with infarct-related artery patency after acute myocardial infarction

AIMS: The study was set up to evaluate the functional role of post-infarctpreserved microvascular integrity. Low dose dobutamine echocardiographyand myocardial contrast echocardiography were used to studypatients before hospital discharge who had suffered a recentmyocardial infarction and had a patent infarct-related artery(TIMI flow grade 3). METHOD: In the dysfunctioning infarct area, the wall motion score indexwas calculated at baseline, during the dobutamine infusion andat the 3 month follow-up echocardiogram; contrast echocardiographywas performed at the time of coronary angiography, before hospitaldischarge. RESULTS: In patients with more than 50% of the dysfunctioning infarctarea opacified at contrast echocardiography (group A), regionalwall motion score index decreased, compared to baseline, duringthe dobutamine infusion (1·97 ± 0·78 vs2·5 ± 0·35 at baseline; P<0·001)and at follow-up echocardiography (1·83 ± 0·63vs 2·5 ± 0·35 at baseline; P<0·001).In patients with less extensive microvascular integrity as revealedby contrast echocardiography (group B), regional wall motionscore index did not decrease from baseline during either thedobutamine infusion (2·73 ± 0·21 vs 2·81± 0·20 at baseline; P=ns) or at follow-up (2·81± 0·20 vs 2·81 ± 0·20 atbaseline; P=ns). CONCLUSION: In patients with post-infarct dysfunctioning myocardium buta patent infarct-related artery, microvascular integrity, asassessed by myocardial contrast echocardiography, is an indicatorof myocardial viability in terms of preserved contractile reserve,as demonstrated by dobutamine infusion and functional recoveryat follow-up.     

Assessment of regional myocardial hypoperfusion with myocardial contrast echocardiography using intravenous bolus application in patients with acute chest pain: a double case report.

Myocardial contrast echocardiography using power Doppler harmonic imaging is able to document myocardial hypoperfusion. Two case reports demonstrate the potential of intravenous bolus application of microbubbles in patients with acute chest pain due to myocardial ischaemia to detect regional low flow conditions. The case reports will focus on the necessity to present Doppler intensity kinetics by Doppler intensity vs time plots or coloured M-modes to present the data more objectively. In addition, the hypoperfusion detected with myocardial contrast echocardiography via bolus injection of microbubbles can only be proven by changes of regional perfusion between repetitive myocardial contrast echocardiography measurements or by additional perfusion analysis, e.g. by scintiscanning.     

实时三维斑点追踪成像结合实时心肌声学造影预测心肌梗死后患者心肌存活性的临床研究

摘要 目的 探讨实时三维斑点追踪成像技术（RT-3D-STI）结合实时心肌声学造影（RT-MCE）技术评价心肌梗死后患者心肌存活性的临床应用价值。方法 选取 25 例根据心电图、心肌酶学及冠脉造影确诊,且成功进行冠状动脉血运重建术的心肌梗死患者。所有患者于术前 1 周内行 RT-MCE 检查,对心肌灌注结果进行半定量评价;分别于术前及术后 6 个月行二维超声分析左室各节段心肌进行室壁运动,根据术后室壁运动是否改善将室壁运动异常的心肌节段分为两组：存活心肌组和非存活心肌组;同时行 RT-3D-STI 技术测得左室心肌整体及各节段三维峰值长轴应变 (3D-LPS) 、环向应变 (3D-CPS) 、面积应变 (3D-APS) 及径向应变 (3D-RPS) 参数指标。结果 血运重建术前,存活心肌组 3D-PLS、3D-PAS、3D-PCS、3D-PRS 明显高于无存活心肌组（P <0.05）;单参数 ROC 曲线分析结果显示,静息状态下,以术前 3D-PAS ≤ -16.5% 作为截断值判断心肌梗死后存活心肌的 AUC 为 0.944,敏感性为 91.3%,特异性为 93.8%,明显高于其它应变值;多参数联合分析结果显示,三维应变参数联合判断心肌梗死后存活心肌的 AUC 为 0.969,灵敏度及特异度分别为 95.7%、 90.6%。血运重建术前,RT-MCE 评价存活心肌的敏感度及特异度分别为 93.1％、 68.8％,一致性分析得出 Kappa 值为0.645。结论 在静息状态下, RT-3D-STI 技术预测心肌梗死后心肌的存活性地价值高于 RT-MCE 技术,其中三维应变参数以 3D-PAS ≤ -16.5% 作为截断值判断心肌梗死后心肌存活性的价值最高,且两种技术联合应用能更好地评价心肌存活性。     

Combination study of myocardial perfusion and left ventricular filling provides an excellent prediction of clinical outcomes in patients with reperfused myocardial infarction

The no reflow phenomenon and left ventricular (LV) diastolic dysfunction are surrogate markers of poor outcomes in patients with myocardial infarction (MI). We studied the relationship between contrast perfusion defects and restrictive filling patterns for predicting prognosis after MI. Mitral inflow velocity and myocardial contrast perfusion were studied 2 weeks after reperfusion in 226 consecutive patients with acute MI. The cohort was divided into two groups according to the number of perfusion defect segments (PD); large-PD and small-PD. Mitral inflow was classified into two categories according to deceleration time; non-restrictive and restrictive. The patients were divided into 4 groups (small-PD/non-restrictive, n = 124; small-PD/restrictive, n = 29; large-PD/non-restrictive, n = 50; large-PD/restrictive, n = 23). LV end-diastolic volume index was the greatest and cardiac event rate was the highest in large-PD/restrictive, followed by large- PD/non-restrictive, small-PD/restrictive, and by small- PD/non-restrictive (81 ± 19 vs. 74 ± 17 vs. 66 ± 19 vs. 59 ± 15ml/m2, events: 61 % vs. 16% vs. 14% vs. 8 %). Multivariate analysis revealed the large-PD is the most powerful predictive factor related to cardiac events (odds ratio = 5.5, P = 0.004) followed by the restrictive filing pattern (4.3, P = 0.005). Co-existence of large-PD and restrictive filling is a strong predictor of adverse outcomes in the patients with MI.     

直接和补救性经皮冠状动脉腔内成形术患者血浆丙二醛水平的动态变化及其意义

目的观察直接PTCA和补救性PTCA再灌注过程中血浆丙二醛（malondialdehyde,MDA）的动态变化,并分析其变化的机制和意义。方法对直接PTCA和补救性PTCA成功的40例急性心肌梗死（AMI）患者为研究对象,动态观察入院即刻及血管开通后1、4、8、24、48h和第7天血浆MDA的变化规律。结果(1)AMI患者入院即刻血浆MDA明显高于正常值（P＜0.001）,血管开通后1h达到峰值,而后逐渐下降,到第7天时仍高于入院时水平。再灌注越早,MDA水平越低。(2)心梗后心功能KillipⅡ-Ⅳ级组峰值明显高于Ⅰ级组（P＜0.001）,且出院前射血分数与再灌注后1hMDA水平呈负性相关（P＜0.001）。结论AMI患者行直接PTCA和补救性PTCA后血浆MDA水平明显升高,再灌注后1h达到高峰;延迟再灌注和心梗后心功能恶化可使MDA水平进一步升高。