静息与负荷心肌造影超声心动图识别存活心肌的对比研究

目的探讨负荷心肌造影超声心动图(MCSE)对心肌梗死后存活心肌评价的疗效和安全性。方法选择冠状动脉造影证实的心肌梗死患者30例。首先在静息状态下行心肌造影超声心动图(MCE),MCE心肌灌注结果采用半定量评价。多巴酚丁胺负荷静脉滴注剂量分别为5、10、20μg·kg~(-1)·min~(-1),每期3 min观察心率、血压变化于达到负荷剂量后再次行MCE,并以~(18)F-脱氧葡萄糖正电子发射计算机体层扫描(PET)作为金标准评价其敏感性和特异性。结果 MCE总共评价360个梗死节段,静息MCE评价1、0.5、0分为264、22、74个节段。多巴酚丁胺负荷MCSE评价1、0.5、0分为286、30、44个节段,评价MCE敏感性和特异性分别为38.10%、88.89%,kappa=0.285(P0.01)。评价MCSE敏感性和特异性分别为86.21%、88.89%,kappa=0.746(P0.05)。结论MCE及MCSE安全性良好。MCE及MCSE均与冠状动脉造影心肌梗死部位有较好的相关性,以PET作为金标准,MCSE具有较高的敏感性和特异性,是评价梗死节段内存活心肌的较好方法。

The comparative study of using resting and stress myocardial contrast echocardiography in recognizing viable myocardium

Objective To investigate the efficacy and safety of using MCSE to evaluate myocardial viability after myocardial infarction.Methods Thirty patients confirmed to have myocardial infarction by coronary angiography were studied.First,in the resting state myocardial contrast echocardiography (MCE) was performed and the results of myocardial perfusion was evaluated by semi-quantitative analysis.The infusion dose of dobutamine stress was 5,10,20 μg·kg~(-1)· min~(-1).Changes of cardiac rhythm and blood pressure were observed 3 minutes/period until stress dose,then MCE was performed once again,and ~(18)F-deoxidized glucose PET was used as the gold standard to evaluate its sensitivity and specificity.Results MCSE had good safety.A total of 360 infarction segments were evaluated.In the resting state MCE evaluation 264,22 and 74 segments got 1.0.5 and 0 point respectively.In MCSE evaluation 286,30 and 44 segments got 1.0.5 and 0 point respectively.The sensitivity and specificity of MCE were 38.10% and 88.89% respectively compared with PET,kappa value was 0.285;those of MCSE were 86.21% and 88.89%,kappa value was 0.746.Conclusions MCE and MCSE have good safety,and have good correlation with myocardial infarction location.MCSE has higher sensitivity and specificity,and is the better method for evaluating myocardial viability within infarction segment.