静息状态超声心动图估测心肌存活性

目的　探讨静息状态超声对心肌存活性估测价值。方法　４９例冠心病患者ＣＡＢＧ前后行静息状态超声心动图检查。根据室壁厚度和心肌行组织回声情况将运动异常节段（ＲＷＭＡ）分为两种类型。类型Ⅰ的超声特征为室壁舒张末期厚度及回声与周围组织相比无明显差别， 该类型虽有ＲＷＭＡ， 但局部心肌以存活心肌为主。类型Ⅱ的超声特征为： 舒张末期室壁厚度与周围组织相比明显变薄， 失去正常心肌的颗粒状细回声， 心肌组织回声明显增强呈线状或条状索状， 无法区分心内膜、肌层和心外膜， 正常心肌的三层结构消失， 该类型的心肌主要为瘢痕组织， 失去了心肌存活性。所有患者术后７天至２３月复查静息状态超声心动图， 以术后室壁运动计分较术前改善１分以上为心肌具有存活性， 反向运动、室壁瘤节段变为运动消失和（或）反向运动不认为有存活。结果　２３３个ＲＷＭＡ中表现为类型Ⅰ的１３８段， 其中运动减低６１段， 运动消失７７段。术后运动减低有４８段、运动消失３９段室壁运动改善。表现为类型Ⅱ有的９５段， 其中运动减低２１段， 运动消失３９段， 反向运动１６段， 室壁瘤１９段。术后室壁运动无改善的运动减低、消失、反向运动和室壁瘤分别为１７、３６、１６和１９段。类型Ⅱ中有７个节段术

The value of resting echocardiography in the prediction of recovery of viable myocardium

Objective To predict the valve of rest echocardiography in the identification of viable mvocardium.Methods Forty-nine patients underwent resting echocardiography before and after CABG.According to the diastolic thickness of LV wall and acoustic reflection,we classified the RWMA into two types.The characteristics of type Ⅰ was:normal diastolic thickness and acoustic reflection compared with adjacent normal myocardium. We regarded this type as viable myocardium.The characteristics of Type Ⅱ was:a reduetion of wall thickness,an increase in acoustic reflection,can not differentiatiate the 3 layers of normal myocardium,that is,endocardium.myocardium and epicardium.This type was regarded as the scar tissue and can not recover after revascularization. Results of 784 LV segments,233 had RWMA.138 segments were regarded as type Ⅰ.of these,61 were hypokinetic and 77 akinetic.After CABG there were 48 hypokinetic and 39 akinetic segments of type Ⅰ showed improvement.95 segments were regamed as typeⅡ.of these,21 were hypokinetic,39 akinetic,16 dyskinetic and 19 aneurysmal.After operation,17 hypokinetic,36 akinetic and all dyskinetic and aneurysmat segments did not recover. There were 7 segments of typeⅡ improved after CABG.Thus,with combination of type Ⅰ andⅡ,the value of resting echocardiography in the predicting of viable myocardium is as follows:sensitivity 92.6%,specificity 63.3%,PPV 63.0%,NPV 92.6%,and accuracy 75.1%.Conclusions This method is very simple and useful in predicting whether the RWMA segments will recover after revascularization or not,especially useful in predicting segments which will not recover.