选择性心肌声学造影与心肌显色分级评价冠状动脉介入后心肌灌注的对比研究

目的应用选择性心肌超声造影（MCE）及心肌显色分级（MBG分级）评价冠状动脉介入治疗（PCI）后病变心肌灌注情况,并对两种评价方法做出比较。方法24例PCI成功开通冠状动脉的冠心病患者,于PCI前后分别采用MBG分级以及冠状动脉内MCE观察梗死相关血管供应节段心肌显影效果、观察梗死相关动脉前向血流,评估及分析心肌灌注情况,出院前采用二维超声和组织多普勒随访患者左室射血分数及各节段收缩期峰值速度。结果①MBG提示66.7%的患者在PCI成功开通冠状动脉后灌注改善;②冠脉内MCE显示注入造影剂即刻能够获得清晰心肌显影,患者均获得较满意左心室及心肌显影效果,MCE显示约70%节段开通冠状动脉后灌注好转,局部心肌灌注量提高;③“罪犯”血管对应心脏节段PCI术后收缩期峰值速度较术前提高,术后5天左心室射血分数（EF值）较术前增加;④相关性分析提示PCI术后MCE灌注量与术后左心室射血分数密切相关,并能预测心肌局部收缩功能改善。结论PCI即刻多数心肌灌注得到改善,MBG分级及选择性MCE均能显示心肌灌注状态,而选择性MCE能量化局部心肌灌注状态,并能预测PCI术后近期随访心脏整体及节段收缩功能,因此选择性MCE优于MBG。

Comparison between selective myocardium contrast echocardiography and myocardium blush score on the myocardium perfusion after percutaneous coronary intervention

Objective To explore the myocardium perfusion improvement after percutaneous coronary intervention (PCI) by selective myocardium contrast echocardiography (MCE) and myocardium blush grade (MBG) and compare the two different methods in assessing the tissue perfusion after PCI. Methods MBG and intracorony MCE were performed before and after PCI in 24 patients with successful PCI (TIMI III flow achieved in epicardial artery). Both left ventricle ejection fractions (LVEF) as well as peak systolic velocity of the ischemic segments were measured before and 5 days after PCI with 2D echocardiography and tissue Doppler imaging (TDI). Results Myocardium perfusion improved significantly after PCI were demonstrated by MCE and MBG. LVEF and segmental peak systolic velocity were also significantly improved. MCE (r=0.77, P<0.001) better correlated with improvement in LVEF 5 days after PCI than MBG (r=0.14, P>0.05). ROC result revealed that segmental perfusion evaluated by MCE after PCI could predict the segmental peak systolic velocity (sensitivity:82%,specificity: 80%,P<0.001). Conclusion Both MCE and MBG can reveal the perfusion status of myocardium. Intracoronary MCE can accurately quantity myocardium perfusion and predict short-term regional wall systolic function simultaneously. Intracoronary MCE has better clinical application value compared with MBG.