心肌灌注造影在多巴酚丁胺负荷前后早期诊断冠心病的临床研究

目的探讨心肌灌注造影(MCE)技术在大剂量多巴酚丁胺负荷前后早期诊断冠心病的价值.方法 对临床疑为冠心病患者38例,进行大剂量多巴酚丁胺负荷超声心动图试验,分别在静息状态和多巴酚丁胺负荷超声心动图试验终止时即刻行MCE检查.以冠状动脉造影为金标准将大剂量多巴酚丁胺负荷超声心动图前后心肌灌注状态目测法对冠心病的检出率进行比较.结果 多巴酚丁胺负荷超声心动图检查的38例患者中,9例(24%,9/38)达到峰值负荷水平,22例(58%,22/38)达到中级负荷水平.其中通过冠状动脉造影诊断的27例冠心病患者在多巴酚丁胺负荷前后,通过心肌灌注状态目测法诊断心肌缺血患者的例数分别为10例(37%,10/27)及24例(89%,24/27,χ2=15.565,P＜0.01).结论 大剂量多巴酚丁胺负荷超声心动图结合MCE可提高缺血心肌的检出率,发现隐匿性心肌缺血,为临床无创性诊断早期冠心病患者提供新方法.

The value of myocardial contrast echocardiography combined with dobutamine stress echocardiography in early diagnosis of coronary artery disease

Objective To investigate the value of myocardial contrast echocardiography(MCE)combined with high-dose dobutamine stress echocardiography(DSE)in the early diagnosis of coronary artery disease(CAD).Methods The dobutamine stress MCE and SonoVue contrast infusion were performed before an elective percutaneous coronary intervention in 38 patients with suspected CAD.The total and regional perfusion were scored as normal or abnormal and attributed to the three main epicardial coronary arteries using a 16-segment left ventricular model.Results An intermediate stress level was obtained in 22(58%)patients,and 9(24%)patients were obtained with peak stress.Twenty seven of 38 patients were diagnosed as CAD by quantitative coronary angiography.A perfusion defect was detected in 89% of the patients at peak stress,compared to 37% at baseline,there was significant difference(χ2=15.565,P<0.01).Conclusions The MCE combined with DSE can increase the sensitivity of myocardial ischemia detection.As a new non-invasive method,MCE combined with DSE could be used in the early diagnosis of CAD.