超声斑点追踪技术结合小剂量多巴酚丁胺负荷试验评价经皮冠状动脉介入治疗效果

目的利用超声斑点追踪成像(STE)技术结合小剂量多巴酚丁胺负荷(DSE)试验预测经皮冠状动脉介入治疗的效果。方法对40例缺血性心脏病患者,于冠状动脉介入治疗(PCI)术前分析其运动异常心肌节段静息与DSE条件下收缩期峰值应变率(SRs)变化。PCI术后9个月复查心脏超声,以室壁运动分数改善作为判断心肌存活的标准。结果 PCI前225个运动异常心肌节段中,术后101个节段室壁运动明显恢复(44.89%),判定为存活心肌,124个节段运动无明显改善(55.11%)。单独应用DSE准确预测72个节段为存活心肌敏感度71.29%(72/101)],87个节段未恢复心肌特异度70.16%(87/124)]。STE静息状态下ROC曲线下面积为0.76;SRs截断点-0.49,敏感度71.30%,特异度70.20%;结合DSE后ROC曲线下面积为0.89,SRs截断点-0.75,敏感度89.10%,特异度90.30%。无论静息还是DSE条件下存活心肌SRs均显著大于未恢复心肌(P<0.01)。结论STE与DSE相结合可显著提高预测存活心肌的准确性。潜在的有功能的存活心肌可作为筛选PCI适应证和预测PCI疗效的可靠指标。

Speckle tracking echocardiography combined with low dose dobutamine stress in predicting therapeutic effect of percutaneous coronary intervention

Objective To evaluate the feasibility and diagnostic accuracy of speckle tracking echocardiography(STE) combined with low-dose dobutamine stress(DSE) for prediction therapeutic effect of percutaneous coronary intervention(PCI).Methods Forty patients with ischemic heart disease before PCI were included.The longitudinal peak systolic strain rate(SRs) at rest and at DSE was analyzed.Cardiac ultrasound was performed on all patients 9 months after PCI,and improvement of wall-motion score was taken as standard of evaluation.Results Among 225 segments with abnormal resting motion,functional recovery was found in 101(44.89%),while no recovery was found in 124 segments(55.11%) after PCI.At baseline dobutamine echocardiography,72 viable segments were accurately predicted by wall-motion analysis,yielding a sensitivity of 71.29%(72/101),while 87 of 124 segments that did not recover after revascularization were accurately predicted by wall-motion analysis,yielding a specificity of 70.16%(87/124).The area under ROC curves was 0.76,cut-off value of SRs was-0.49,the sensitivity was 71.30% and specificity was 70.20% at rest-state STE.For STE combining with DSE,the area under ROC curves was 0.89,cut-off value of SRs was-0.75,the sensitivity was 89.10% and specificity was 90.30%.SRs of the viable segments were found significantly increased than those did not recovered(P<0.01) when observed with STE.Conclusion Combination of STE with DSE can predict myocardial viability accurately.The presence of potential and functional viable myocardium is necessary in screening indication and forecasting the therapeutic effect of PCI.