多巴酚丁胺超声负荷试验结合组织多普勒定量检测冠心病人存活心肌

目的在超声多巴酚丁胺负荷试验（DSE）中应用组织多普勒（DTI）技术,定量检测存活心肌运动速度的变化,提高存活心肌的检出率。方法25例研究对象均经定量冠状动脉造影（QCA）检查确诊为冠心病,均采用标准的DSE方案（0～40μg/kg·min）,左室室壁节段按照美国超声心动图学会16节段划分法,用目测半定量四级分法观测室壁运动的情况,逐级进行记分,计算室壁运动记分指数（WMSI）。使用DTI技术,分别于静息状态、小剂量（10μg/kg·min）及峰值剂量时观察16个节段心肌运动速度的变化,记录各室壁节段的收缩期（S）、舒张早期（E）及舒张晚期（A）的峰值速度V,将检出结果与冠脉介入性治疗（Percutaneous transluminal intervention,PCI）后的结果作对照,分别计算2D-DSE、DTI-DSE检出存活心肌的敏感度、特异度、阳性预测值、阴性预测值和准确性。结果δVs和δVE≥35%作为判断双相反应的标准：DTI-DSE方法存活心肌的检出率为76%;与2D-DSE相比有显著性差异（76%vs66%,P〈0.05）。两种方法检测存活心肌的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为：2D-DSE：68%、80%、73%、87%和82%;DTI-DSE：82%、88%、86%、84%和85%。结论DTI-DSE技术可定量评价CAD患者存活心肌的运动,对CAD存活心肌的诊断具有较高的应用价值。

Dobutamine stress echocardiography combined with tissue Doppler imaging detecting hibernating myocardium Quantitatively in patients with coronary artery disease

Objective To detect viable myocardium quantitatively, and improve the rate of detecting viable myocardium by Doppler Tissue Imaging during dobutamine stress echocardiography（DSE）. Methods 25 cases who had been admitted for a quantitative coronary angiography（QCA）with at least one of the coronary lesion larger than 50% of luminal diameter occlusion were enrolled in standard dobutamine stress echocardiography（DSE）. Left ventricule wall motion were graded and marked in a semi- quantitative motion using the standard 16-segment 4-score model. Wall motion score index（WMSI） was calculated. The development of the new or worsening regional wall motion abnormality was considered indicatively of positive DSEDSE（＋）]. From DTI spectrum, both peak systolic velocity（Vs）, peak early diastolic velocity（Ve）, peak late velocity（Va） were measured in each segment at base line, 10μg/ Kg. min and peak-dose dobutamine infusion. The sensitivity, specificity, positive predictive value （PPV） ,negative predictive value（NPV） ,and accuracy were calculated after the results of DSE were compared with those of Percutaneous transluminal intervention（PCl）. Results The peak velocity of Doppler Tissue Imaging was gained in 16 segments of left ventricular of every patients, and the AVS and 6VE≥ 35% were regarded as the standard of double response. The rate of detecting viable myocardium using DTI-DSE was 76% ,while 2D-DSE was 66% ,the difference was significantly. The sensitivity, specificity, positive predictive value （ PPV）, negative predictive value （ NPV）, and accuracy were： 2D- DSE ： 68 %, 80 %, 73 %, 87 % and 82 % respectively; and DTI --DSE： 82 %, 88 %, 86 %, 84 % and 85 % respectivel. Conclusions DTI-DSE could detect hibernating myocardium quantitatively in patients of CAD, and the rate of detecting viable myocardium was improved significantly.