多巴酚丁胺负荷多普勒组织超声心动图预测PTCA术后冬眠心肌功能改善的价值

目的：探讨PWDTI结合LDDSK预测PTCA术后冬眠心肌功能改善的价值。方法：采用PWDTI结合LDDSK测量36例陈旧性心梗患者(静息下观察82个室壁运动异常节段)PTCA术前1天静息下和负荷下室壁运动异常节段峰值收缩速度Vs，并计算负荷下S％增长。PTCA术后4～6周随访分析。结果：PTCA术后，46节段室壁运动改善，36节段室壁运动未改善。以S％＞35％为裁断值，PWDTI结合LDDSK预测PTCA术后室壁功能改善的敏感性86．9％、特异性86．1％、准确性86．6％、阳性预测值88．9％、阴性预测值83．8％。结论：脉冲多普勒组织成像结合多巴酚丁胺负荷超声心动图可识别冬眠心肌并准确地预测PTCA术后局部左室功能改善。

Value of Predicting Hibernating Myocardium After PTCA by Dobutamine Tissue Doppler Echocardiography

Objective:To evaluate the value of predicting hibernating myocardium after PTCA by pulsed wave Doppler tissue imaging(PWDTI)associating with Dobutamine stress echocardiography.Methods:Percutaneous transluminal coronary angioplasty(PTCA)was performed in 36 patients with old myocardial infarction and 82 segments of resting dyskinetic wall motion at baseline were observed.Peak systolic velicity(Vs) was measured in abnormal walls at baseline and pulsed wave Doppler tissue imaging combined with dobutamine stress echocardiography(DSE)one day before PTCA.Increment of Vs was defined during stress echocardiography(S%).The follow up analysis was performed 4 weeks after PTCA.Results:The dyskinetic motion of 46/82 segments was improved according to the follow up echocardiography 4 weeks after PTCA while that of 36/82 segments was not.Assuming 35% as a cut off for motion improvement of the left ventricular dyskinetic segments the increase in Vs by DSE yielded 86 9% of sensitivity,86 1% of specificity and 86 6%.of accuracy for predicting hibernating myocardium after PTCA,whereas positive predicting and negative predicting accuracy were 88 9% and 83 8%,respectively.Conclusions:Pulsed wave tissue Doppler imaging combined with DSE can identify hibernating myocardium and predict the motion improvement of the left ventricular dyskinetic segments.