负荷超声心动图对心肌梗死后存活心肌的识别与评价

目的采用小剂量多巴酚丁胺负荷超声心动图(LDDSE)对心肌梗死患者的存活心肌进行评估,评价心肌梗死后冠状动脉血运重建术(CRV)对有存活心肌和无存活心肌室壁运动、心室重构及心功能改善的恢复状况。方法 80例心肌梗死患者于CRV术前1周内行静息超声心动图和LDDSE,观察患者室壁运动异常节段的变化,评估存活心肌情况,并在CRV术后3~5个月内复查LDDSE。于术前术后测定左心室收缩功能,并进行对比分析。结果 LDDSE对室壁节段功能恢复情况的预测准确性为86.4%,术前LDDSE检测的心肌节段数与术后左室舒张末容积(LVEDV)呈显著正相关(r=0.47,P﹤0.05),CRV术后改善收缩功能的心肌节段数与术后LVEDV呈线性显著正相关(r=0.61,P﹤0.05)。结论 LDDSE除评价存活心肌的数量外,还可评估、预测CRV术后心室的收缩功能,能够指导临床选择治疗方案,预测疗效和评估预后。

Identification and evaluation on the myocardial viability after myocardial infarction using stress echocardiography

Objective To evaluate the myocardial viability in patients with myocardial infarction with low-dose dobutamine stress echocardiography（LDDSE ）, data of the wall motion, ventricular remodeling and the cardiac function were evaluated after coronary revascularization （CRV）. Methods Eighty patients with myocardial infarction were included, echocardiography and LDDSE were performed one week before CRV and within 3-5 months after CRV, changes of segmental wall motion, myocardial viability were evaluated. Preoperative and postoperative left ventricular systolic function was assessed either. Results The accuracy of prediction for segmental wall functional recovery using LDDSE test was 86.4%. The number of segments of myocardial infarction detected using preoperative LDDSE is positively correlated to the postoperative left ventricular end- diastolic volume（LVEDV）, r was 0.47（P 〈 0.05 ）. The number of segments improved after CRV is magnificently linearly correlated to postoperative LVEDV, r was 0.61 （P 〈 0.05）. Conclusion LDDSE is a useful tool for evaluation on the number of viable myocardium, and it is potentially to predict CRV postoperative ventricular systolic function, which is helpful to chose the treatment strategy, predict the efficacy and prognosis.