小剂量腺苷负荷超声心动图试验与双核素心肌显像检测急性心肌梗死后患者存活心肌比较

目的:比较小剂量腺苷负荷超声心动图试验(LDASE)与99mTc-甲氧基异丁腈(MIBI)/18F-脱氧葡萄糖(FDG)双核素同时采集法(DISA)单光子发射断层显像(SPECT)对急性心肌梗死(AMI)患者早期存活心肌检出的准确性.方法:对36例AMI患者于发病后3～10 d内行LDASE与DISA-SPECT.所有患者在LDASE前后接受经皮冠状动脉介入治疗术.AMI后3个月随访二维超声心动图,以局部室壁运动改善作为心肌存活的金标准,比较2种方法检测存活心肌的敏感性和特异性.结果:LDASE检出存活心肌敏感性为90.3%,特异性为80.8%,阳性预测值与阴性预测值分别为84.8%和87.5%,准确性为86.0%;DISA-SPECT检出存活心肌敏感性81.2%,特异性78.3%,阳性预测值81.1%,阴性预测值83.1%,准确性80.2%.2种方法对运动异常节段存活心肌检出一致性为72.6%,差异无统计学意义.结论:对AMI后患者,LDASE与DISA-SPECT均为检出存活心肌较敏感和特异的技术.     

二维应变成像结合腺苷负荷超声心动图评价犬存活心肌

目的 探讨二维应变成像结合腺苷负荷超声心动图评价存活心肌的新方法.方法 15只健康杂种犬,结扎其冠状动脉前降支90 min后,恢复血流灌注120 min,建立急性心肌梗死再灌注模型.分别于基础状态下(结扎前)和再灌注后采集心尖三腔、两腔和短轴二尖瓣、乳头肌、心尖水平的图像.随后泵入腺苷并重复采集图像.以氯化三苯基四氮唑溶液(2,3,5-triphenyl tetrazolium chloride,TTC)染色结果测量梗死面积(SN)与该节段总面积(S)的百分比(SN/S),SN/S≤50%即为存活心肌.将前壁、前间壁各节段分为存活心肌和非存活心肌,运用二维应变成像技术定量评价犬不同状态下存活与非存活心肌径向、纵向及圆周的收缩期峰值应变(peak-systolic strain,Speak sys)并进行比较.结果 存活与非存活心肌分别为37和53个节段.(1)基础状态下:存活与非存活心肌的收缩期峰值径向应变(RSpeak sys)、纵向应变(LSpeak sys)及圆周应变(CSpeak sys)比较差异无统计学意义.(2)再灌注120 min后:存活与非存活心肌的RSpeak sys、LSpeak sys及CSpeak sys(绝对值)均低于基础状态,而存活心肌与非存活心肌组间差异无统计学意义.(3)腺肾负荷后:与再灌注120 min后相比,存活心肌的RSpeak sys、LSpeak sys显著升高(P<0.01或P<0.05),且存活心肌的RSpeak sys、LSpeak sys明显高于非存活心肌(P<0.01).(4)腺苷负荷后,RSpeak sys与SN/S呈负相关(r=-0.72,P<0.01),CSpeak sys及LSpeak sys与SN/S呈正相关(r值分别为0.40和0.67,P均<0.01).(5)将腺苷负荷前、后应变数值的变化率(△RSpeak sys和△LSpeak sys)作为研究对象,以△RSpeak sys≥13.5%作为判断心肌存活的最佳截断值,其识别存活心肌的敏感性和特异性分别为83.8%、83.0%;以△LSpeak sys≥11%作为最佳截断值,其敏感性和特异性分别为78.4%、88.7%;联合△RSpeak sys和△LSpeak sys两项指标,其敏感性和特异性分别为91.9%、79.2%.结论 二维应变成像技术结合腺苷负荷超声心动图能比较准确地区分存活心肌与非存活心肌.     

腺苷负荷超声心动图识别存活心肌的应用研究

目的探讨腺苷超声心动图负荷试验(ATE)在识别存活心肌中的应用价值及安全性.方法59例心肌梗死后患者静脉注射腺苷,剂量为90 μg/min持续3 min,加量至110 μg/min持续3 min,检出二维超声室壁改善节段作为存活心肌节段,与治疗后随访结果--"金标准"比较,分析两者的符合率及试验中患者发生的不良反应的情况.结果腺苷负荷后,患者心率增加、血压下降,但幅度较小;ATE识别存活心肌的敏感性90.4%,特异性90.5%;未发生严重不良反应.结论ATE识别存活心肌是一种可靠、安全、有效的方法.     

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。     

小剂量多巴酚丁胺超声心动图试验和双核素心肌显像检测急性心肌梗死后患者存活心肌比较

目的比较小剂量多巴酚丁胺超声心动图试验（LDDE）和^99mTc-甲氧基异丁腈（MIBI）／^18F-脱氧葡萄糖（FDG）双核素同时采集法（DISA）单光子发射型断层显像（SPECT）对急性心肌梗死早期存活心肌检出的准确性。方法对44例急性心肌梗死患者于发病后5～10天内行LDDE和DISA—SPECT,所有患者在LDDE和DISA检查后接受经皮冠状动脉介入术。两种方法均采用16节段半定量法分析图像。心肌梗死后3个月随访二维超声,以局部室壁运动改善作为心肌存活标准,比较两种方法检测存活心肌的敏感性和特异性。结果LDDE检出存活心肌的敏感性、特异性、诊断准确性、阳性预测值和阴性预测值分别为77％、82％、79％、82％和77％。DISA检出存活心肌的敏感性、特异性、诊断准确性、阳性预测值和阴性预测值分别为85％、62％、74％、71％和79％。LDDE和DISA两者对运动异常节段检出存活心肌的一致性为70％。对于运动减低节段,LDDE和DISA对存活心肌检出率差异无统计学意义（74．1％比77．6％,P〉0．05）;对于无运动节段,LDDE对存活心肌检出率低于DISA（29％比53％,P〈0．01）。结论对急性心肌梗死后的患者,DISA检出存活心肌的敏感性高于LDDE,而特异性低于LDDE,联合应用起互补作用,提高检测存活心肌的能力。     

小剂量多巴酚丁胺超声心动图评价急性心肌梗死存活心肌的研究

目的　探讨梗死相关血管重建后存活心肌的功能恢复与左室重塑进程和左室功能恢复的关系。方法　将心肌梗死区异常室壁运动节段中存活心肌的节段数做为量化存活心肌的指标。筛选 4 8例初次急性心肌梗死患者 ,心肌梗死后 (2 0± 12 )天成功的接受梗死相关血管的介入治疗术 ,术前 1～ 3天接受静息超声心动图和小剂量多巴酚丁胺负荷超声心动图检查 ,术后 (5 4± 1 6 )个月复查静息超声心动图。依小剂量多巴酚丁胺超声心动图负荷试验检测出的梗死相关的异常室壁节段中存活心肌的节段数 ,将 4 8例患者分为 :Ⅰ组 ,大量存活心肌 (存活心肌节段≥ 6段 ) 11例 ,Ⅱ组 ,少量存活心肌 (2段≤存活心肌节段≤ 5段 ) 2 9例 ,Ⅲ组 ,无存活心肌 (存活心肌节段 <2段 ) 8例。分别测定术前和术后静息状态下的左室舒张末容积、左室收缩末容积、左室射血分数和左室室壁节段运动积分指数。结果　重建血管术后 (5 4± 1 6 )个月随访发现梗死相关动脉血管重建后 ,梗死相关血管的异常室壁运动有不同程度的改善 ,Ⅰ组的左室收缩末容量由 (6 3± 8)ml降至 (4 7± 10 )ml(P <0 0 1) ;室壁运动积分指数由 1 4± 0 2降至 1 1± 0 1(P <0 0 1) ,左室射血分数由 (4 6± 9) %增至 (5 7± 10 ) % (P<0 0 1)。Ⅱ组的左室收缩末容量 (7     

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     

老年急性心肌梗死患者的组织谐波超声心动图检查

目的探讨组织谐波超声心动图(THE)在老年人急性心肌梗死诊断中的应用价值。方法对本院136 例经THE检查的老年初发Q波急性心肌梗死患者的临床及超声心动图资料进行分析。结果男95例,女41例,年龄60-89岁,平均(68±7)岁。THE图像满意率92％(125/136)。THE图像满意者中检出急性心肌梗死117例(94％)。 THE与心电图判断心肌梗死的部位及范围基本一致,尤其是对于急性广泛前壁和前壁心肌梗死,两者的判断高度一致。THE所示心肌梗死部位与冠状动脉造影所示梗死相关动脉供血区域符合率93％。结论 THE能够敏感、准确地检出老年急性心肌梗死患者,可作为早期诊断老年人急性心肌梗死的补充手段。     

腺苷超声心动图与腺苷负荷心肌灌注显像诊断冠心病的价值

目的探讨腺苷超声心动图负荷试验(ASF)与腺苷负荷~(99m)Tc心肌灌注显像(Ad-SPECT)诊断冠心病的价值。方法选择临床拟诊断为稳定性心绞痛的住院患者86例,同期行ASE和Ad-SPECT单项及联合试验,观察腺苷静脉滴注后心率、血压及其不良反应发生情况。结果 86倒患者接受冠状动脉造影检查,阳性62例,阴性24例。ASF诊断冠心病的敏感性、特异性和准确度分别为74%、79%和76%,Ad-SPECT分别为87%、62%和80%,ASE及Ad-SPECT的联合平行试验敏感性、特异性和准确度分别为97%、63%和87%,联合系列试验分别为65%、88%和80%。联合平行试验的敏感性与各单项试验敏感性之间、联合系列试验的特异性与各单项试验特异性之间差异有统计学意义(P<0.05)。结论腺苷负荷试验安全、可靠,ASE及Ad-SPECT诊断冠心病特异性、敏感性均较高,联合试验可进一步提高诊断冠心病的价值。     

心肌存活性对急性心肌梗死后左室重构和左心功能的影响

目的:探讨急性心肌梗死(AMI)患者梗死区心肌存活性对心脏功能的影响.方法:采用回顾性对比研究的方法,62例AMI患者以99mTc-MIBI SPECT静息显像及18F-FDG SPECT心肌代谢显像的检查结果分为梗死区有存活心肌组和无存活心肌组,介入治疗后随访12个月,应用超声心动图评价2组患者的心脏功能.结果:有存活心肌组左室射血分数均显著高于无存活心肌组[术前:(54.25±1.60)%:(47.20±1.83)%,P＜0.01;12个月:(58.09±1.88)%:(50.00±2.06)%,P＜0.01],有存活心肌组左室舒张末期内径均显著优于无存活心肌组[术前:(51.31±0.95)mm:(54.33±1.07)mm,P＜0.05;12个月:(51.65±1.12)mm:(56.10±1.38)mm,P＜0.05].左房内径及舒张期二尖瓣血流速度峰值的比值2组随访时均无显著变化.结论:AMI后梗死区有存活心肌的患者心脏整体收缩功能及左室重构显著优于无存活心肌的患者,但心肌存活性对左心室舒张功能无明显影响.     

QTVI结合小剂量多巴酚丁胺负荷试验检测存活心肌的评估

目的:应用定量组织多普勒速度成像（QTVI）结合小剂量多巴酚丁胺负荷试验（LDDS）评价存活心肌。方法:结扎犬LCX建立急性心肌梗死模型,分别于LDDS前、后记录心尖3个切面组织多普勒图像,根据QTVI在负荷前后变化特征确定存活心肌,并与三苯四氮唑溶液（TTC）染色及心肌声学造影对照。结果:LDDS前,存活心肌与非存活心肌节段间收缩期峰值速度（Vs）和收缩期最大位移（D s）比较无显著性差异（P>0.05）,LDDS后与LDDS前相比,存活心肌节段的室壁Vs及D s显著升高（P<0.01）,无存活心肌室壁Vs及D s变化无统计学意义（P>0.05）,LDDS中以负荷前后收缩期速度变化差值（△Vs）>0.66 cm/s作为截断值判断存活心肌的敏感性83%,特异性87%,以负荷前后收缩期位移变化差值（△D s）>0.61 mm作为截断值判断存活心肌的敏感性为80%,特异性为89%。结论:应用QTVI与LDDS结合,可以检测梗死区的存活心肌。     

Significance of ST-segment elevation during dobutamine-stress echocardiography in patients with acute myocardial infarction treated with thrombolysis

BACKGROUND: Stress-induced ST-segment elevation in patients with recentmyocardial infarction treated with thrombolysis has not beenextensively investigated. According to the results of previousstudies it may represent residual myocardial ischaemia or dyskinesiain the infarcted region. The aim of the study was to analysethe significance of dobutamine-induced ST-segment elevationin the infarcted area in a consecutive group of patients (n=42,41 men, mean age 53 ± 7 years) with a first acute myocardialinfarction treated with thrombolysis within 6 h from symptomsonset. METHODS AND RESULTS: All patients underwent dobutaminestress echocardiography (upto 40 µg. kg^–1. min^–1+ atropine) 7 ±3 days from the acute event and coronary arteriography within1 month from the test. Significant ST-segment elevation wasdefined as a shift 1 mm during dobutamine compared to baselinein at least two contiguous infarct-related leads; a correlationwas made between the site of ST-segment elevation and wall motionchanges during dobutamine. Dobutamine-induced ST-segment elevationin 23/42(55%) patients (group 1) while no changes were observedin 19/23 (45%) patients (group 2). Compared to group 2, group1 patients showed a higher asynergy score index (1·72± 0·24 vs 1·50 ± 0·32, P<0·02)and a higher number of asynergic segments (5·04 ±1·9 vs 4·11 ± 1·8), at baseline,a higher incidence of baseline and/or stressinduced dyskinesia(39 vs 10%, P<0·05) in the infarct-related regionand a higher percentage of occluded infarct-related arteries(48 vs 0%, P<0·001). In the 42 patients studied, asignificant correlation was found between baseline ST-segmentelevation and baseline asynergy score index (RS=0·56,P<000l) and between ST-segment elevation and asynergy scoreindex at peak stress (RS=0·55, P<0·001). Theincidence of reversible wall motion abnormalities indicativeof myocardial viability and residual myocardial ischaemia wassimilar in the two groups (87 vs 84% and 74 vs 68%, respectively),while the number of segments with irreversible akinesia indicativeof myocardial necrosis was higher in group 1 compared to group2 (1·5 ± 14 vs 0·9 ± 1·4).Among the 23 patients of group 1 with dobutamine-induced ST-segmentelevation, six had no reversible wall motion abnormalities indicativeof myocardial ischaemia; of the 17 patients with myocardialischaemia, 11 had 50% and six had 50% of basally asynergic segmentsshowing reversible wall motion abnormalities. CONCLUSIONS: In patients with recent thrombolyzed myocardial infarction dobutamine-inducedST-segment elevation is associated with a larger akinetic areain basal conditions and either with reversible wall motion abnormalitiesindicative of myocardial ischaemia or with irreversible or minimallyreversible wall motion abnormalities in the infarct area duringthe test. Thus, dobutamine echocardiography provides usefulinformation for the interpretation of stress-induced ST-segmentelevation and clinical management of these patients.     

急性心肌梗塞患者再灌注治疗后ST段回落的影响因素

目的:分析急性心肌梗塞(AMI)患者再灌注治疗后ST段回落(STR)的影响因素。方法:收集114例溶栓和71例急诊经皮冠状动脉介入(PCI)治疗的AMI患者,按溶栓或PCI治疗后90min心电图单导联STR分别分为STR<50%和STR≥50%组,对临床资料中多个变量进行单因素分析和Logistic回归分析。结果:单因素分析显示,与STR<50%患者相比,PCI组STR≥50%患者入院时血糖(Glu)(P=0.016)和白细胞(WBC)(P=0.011)较低,单支冠脉血管病变者较多(P=0.023),溶栓组STR≥50%患者Glu(P=0.002)、WBC(P=0.036)和killip心功能分级(P=0.012)较低,发病到治疗的时间更短(P=0.016),有高血压病史者(P=0.033)和前壁梗塞者(P=0.011)较少。Logistic回归分析结果PCI组最终进入方程的变量为入院时Glu(B=-0.299,P=0.021)和WBC(B=-0.201,P=0.026),溶栓组进入方程的变量有高血压病史(B=-0.978,P=0.027)、GIu(B=-0.252,P=0.003)和治疗前时间(B=-0.004,P=0.018)。结论:入院时血糖水平为AMI患者PCI或溶栓治疗后ST段回落独立的影响因素,WBC是PCI患者ST段回落的另一影响因素,高血压病史和治疗前时间则是溶栓治疗患者ST段回落的另外两个影响因素。     

硝酸甘油介入99mTc-MIBI心肌显像研究梗死区心肌活力与临床因素的关系

目的 :探讨心肌梗死 ( MI)病人心肌存活情况的临床相关因素。方法 :对 62例 MI病人行静态和硝酸甘油 ( NTG)介入 SPECT心肌显像。结果 :NTG介入后 64 .5 % ( 40 /62 )的病人心肌灌注改善 ,即有存活心肌存在。经统计学处理 ,中年组比老年组有较多的存活心肌 ( P <0 .0 5 ) ,有不稳定型心绞痛的 MI病人有存活心肌的比率高于稳定型心绞痛或无心绞痛者 ( P<0 .0 5 )。结论 :根据MI病人的临床情况可初步估计其心肌活力。     

Comparison of dobutamine stress echocardiography and exercise stress Thallium-201 SPECT for detection of myocardial ischemia after acute myocardial infarction treated with thrombolysis

In order to compare the ability of dobutamine stress echocardiography (DSE) and exercise Thallium-201 SPECT to detect myocardial ischemia in patients with myocardial infarction (Ml) treated with thrombolysis, 43 prospectively selected patients with Ml treated with thrombolysis underwent within 1 month from Ml DSE, stress-redistribution-reinjection Thallium-201 SPECT and coronary angiography. The echocardiographic and scintigraphic images were analyzed for the presence of myocardial ischemia using a 11-segment left ventricular model. DSE and exercise Thallium-201 SPECT detected myocardial ischemia in the infarct zone in 72 and 72 (31/43) of patients and ischemia at a distance in 12 (5/43) and 19 (8/43) of patients with a concordance of 67 and 88 , respectively. A significant agreement between DSE and exercise Thallium SPECT was found in the evaluation of the extent of both myocardial necrosis and stress-induced myocardial ischemia. DSE and exercise Thallium SPECT showed similar sensitivity (79 vs 76), specificity (60 vs 60) and accuracy (77 vs 74) for detection of a critical stenosis of the infarct-related artery; there was also no significant difference between the tests in sensitivity, specificity and accuracy for detection of the multivessel disease.In conclusion, initially after thrombolyzed MI, DSE and exercise Thallium-201 SPECT detect myocardial ischemia in the infarct zone in a high proportion of patients and show a similar accuracy for the diagnosis of a critical stenosis of the infarct-related coronary artery and of the multivessel disease.     

Increased plasma thioredoxin in patients with acute myocardial infarction

BACKGROUND AND HYPOTHESIS: Thioredoxin is an important biomarker for oxidative stress. We investigated whether thioredoxin levels were elevated in patients with acute myocardial infarction (AMI) and were associated with the results of coronary reperfusion. METHODS: The present study determined plasma thioredoxin levels in 51 patients with AMI, 30 patients with stable exertional angina (SEA), and 30 patients with chest pain syndrome (CPS). Plasma sampling was performed on admission, at 12 h, 1 week, 2 weeks, and 4 weeks in patients with AMI, and after admission in patients with SEA and CPS. RESULTS: Plasma thioredoxin levels on admission were higher in patients with AMI than in those with SEA and CPS. Plasma thioredoxin levels in patients with AMI were decreased in 12 h without further change thereafter. However, thioredoxin levels in patients with AMI remained higher than in those with SEA. In multivariate analysis, higher levels of thioredoxin on admission were a risk factor for failure in emergent reperfusion therapy in patients with AMI independent of other factors. CONCLUSION: Plasma thioredoxin levels are elevated in patients with AMI, and higher thioredoxin levels may predict subsequent failed coronary reperfusion therapy in patients with AMI.