实时心肌超声造影多指标联合应用对冠心病诊断的临床价值

目的 探讨实时心肌超声造影(RT-MCE)多指标联合应用对冠心病诊断的临床价值.方法 人选35例患者均行常规超声心动图检查和经静脉RT-MCE,并于RT-MCE检查后2-4 d行门控单光子发射计算机断层显像(gated-SPECT)检查,所有患者均于RT-MCE检查后1周内行冠状动脉造影(CAG)检查.以CAG为金标准分为冠心病组和非冠心病组.采用Qlab软件对造影图像微泡再充盈曲线进行定量分析,求出各节段的最大微泡数量(A)、造影剂充填速度(β)及其乘积A×β值;与CAG结果对比,采用受试者曲线寻求A值、β值及A×β值对冠心病的诊断截断点;对22例冠心病患者行Gensini评分,与A值、β值及A×β值行相关分析.②Gated-SPECT图像中所有节段采用4分计分方法,计算其诊断冠心病的敏感性和特异性.③分析RT-MCE多指标联合应用观察对冠心病的诊断价值.结果 ①A值、β值及A×β值在冠心病组与非冠心病组间差异有统计学意义(P<0.05);RT-MCE定量指标A值、β值及A×β值分别以4.58、0.64及2.73为截断点,其诊断冠心病的敏感性分别为86.O%、80.2%和88.9%,特异性分别为84.1%、64.6%和79.9%;A值、β值及A×β值与Gensini评分间的相关系数分别为-0.79、-0.51和-O.76.②Gated-SPECT诊断冠心病的敏感性和特异性分别为84.8%和82.7%.③A与β、A与A×β及β与A×β联合诊断的敏感性增加,分别为89.1%,90.4%及96.3%.结论 RT-MCE多指标联合应用优于gated-SPECT,可提高诊断冠心病的准确性和评价冠状动脉狭窄的严重程度.

Real-time myocardial contrast echocardiography with multi-indexes for the detection of coronary artery stenosis: comparison with gated single photon emission computed tomography

Objective To evaluate value of multi-indexes of real-time myocardial contrast echocardiography (RT-MCE) for the detection of coronary artery disease(CAD). Methods A total of 35 patients scheduled for coronary angiography underwent RT-MCE, and were undergone gated single photon emission computed tomography(gated-SPECT) after RT-MCE shortly. Coronary angiography was performed within one week of RT-MCE in all patients. All patients were divided CAD and no-CAD group. The observing indexes included: (1)The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Qlab software; A,β and A×β were compared between two groups. The sensitivity and specificity of RT-MCE for detection of CAD were performance by ROC curves Gensini score were calculated in 22 patients. Then the correlation analysis was used for comparing the value of A,β and A×β with Gensini score. (2) The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated by 4 score method. (3) RT-MCE for the detection of coronary artery stenosis with multi-indexes. Results (1) A,β and A×β were significant difference between two groups. The cutoff of A,β and A×β was 4. 58,0. 64 and 2. 73,then the sensitivity and specificity of RT-MCE for detection of CAD were 86. 0% , 80. 2% , 88. 9% and 84.1 % , 64. 6% , 79. 9 % , respectively. The correlation index was - 0. 79, - 0. 51 and - 0. 76 comparing the results of A, β and A ×β with Gensini. (2) The sensitivity and specificity of gated-SPECT for assessment of CAD were 84. 8 % and 82. 7% ,respectively. (3) The sensitivity of multi-indexes RT-MCE increased, the sensitivity was 89. l%,90. 4% and 96.3% when combinated A and β,A and A×β,and β and A×β, respectively. Conclusions RT-MCE with multi-indexes has a valuable application for assessment of CAD. The severity of CAD could be evaluated by RT-MCE.