心肌超声造影结合多巴酚丁胺负荷试验探讨冠心病心肌灌注与心肌收缩功能的关系

目的探讨心肌实时超声造影结合小剂量多巴酚丁胺负荷试验中心肌灌注与收缩功能之间、心肌灌注储备与心肌收缩功能储备之间的关系。方法26例住院患者进行了常规超声心动图、基础状态下和小剂量多巴酚丁胺负荷状态下的心肌超声造影。造影图像采用QLab软件对微泡再充盈曲线进行定量分析,求出各节段的A、β值及其乘积A·β。然后对各节段心肌灌注参数和室壁运动评分进行统计分析。结果在基础状态和负荷状态下,心肌灌注参数(β和A·β值)均随着室壁运动评分的增加而降低(P<0.01)。在小剂量多巴酚丁胺负荷状态下室壁运动改善的节段较无改善者具有较高的心肌灌注储备值(P<0.01)。结论心肌灌注和心肌收缩功能具有很好的相关性,检测心肌灌注储备有助于识别存活心肌。

Relationship between myocardial perfusion and contractile function by use of dobutamine stressing real-time myocardial contrast echocardiography

Objective To explore the relationship between myocardial perfusion and contractile function,as well as the relationship between their reserves.Methods Twenty-six patients referred for coronary angiography and subsequent revascularization underwent real-time myocaidial contrast echocardiography(RT-MCE) at baseline and after low dose dobutamine stress.Wall motion scoring was performed before and after low dose dobutamine administration.The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve.Results Myocardial perfusion parameters were significantly lower in segments with higher scored wall motion than in those with normokinetics or less severe hypokinetics ( P < 0.01).Furthermore,myocardial perfusion reserve was significantly higher in segments with ameliorated wall motion when under stress than those without.Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows their advantages in the exploration of perfusion-contractile concordance,which proves the validity of MCE in the identification of myocardial viability.