实时心肌声学造影结合多巴酚丁胺负荷试验检测存活心肌的临床研究

目的评价实时小剂量多巴酚丁胺(LD-DSE)(10μg·kg~(-1)·min~(-1))负荷心肌声学造影(RT-MCE)试验检测存活心肌的临床价值。方法 22例经彩超检查存在左心室壁节段运动障碍冠心病患者,进行LD-DSE负荷RT-MCE试验、冠状动脉造影(CAG)及介入治疗(PCI),所有狭窄病变行完全血运重建。按美国超声心动图学会16节段划分法获得各运动异常节段显影,图像用目测半定量法分析。术后1、3、6个月时复查心脏超声,以冠脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果普通RT-MCE目测半定量法检测存活心肌的灵敏度、特异度及准确度分别是75.7%、84.2%、78.8%;LD-DSE负荷RT-MCE目测半定量法检测存活心肌的灵敏度、特异度和准确度分别是89.3%、89.5%、89.4%;应用LD-DSE负荷RT-MCE目测半定量法对存活心肌检测的灵敏度有所提高(89.3%比75.7%,P<0.05)。结论 RT-MCE目测半定量法检测存活心肌具有较高的临床价值,LD-DSE负荷RT-MCE可提高其检测价值。

Clinical assessment of viable myocardium by RT-MCE combined with low dose dobutamine stress

Objective To evaluate the value of real-time myocardial contrast echocardiography （RT-MCE） combined with low dose （ 10μg·kg-1·min-1） dobutamine stress echocardiography （LD-DSE） on detecting viable myocardium. Methods Twenty-two hospitalized patients with regional wall motion abnormalities （RWMA） underwent RT- MCE and or RT-MCE with LD-DSE. Images of each segment were acquired and evaluated according to 16-segment model of American Society of Eehocardiography. All patients underwent coronary angiography and percutaneous coronary intervention （ complete revascularization）. The motion of each segment was observed by echocardiography at 1,3 and 6 months after PCI. Images of RT-MCE were semi-quantitatively analyzed. The gold standard of viable myoeardium was that the motion of ventricular segment got better after PCI. Results The sensitivity, specificity and accuracy of RT-MCE on detecting viable myocardium were 75.7% , 84. 2% and 78.8% ,respectively,and those of RT-MCE combined with LD-DSE were 89. 3% , 89. 5% and 89. 4%, respectively. The sensitivity was raised significantly （89.3 % vs. 75.7% ,P 〈 0. 05 ）. Conclusions RT-MCE is a valuable method to detect viable myoeardium, the sensitivity improves when combined with LD-DSE.