小剂量腺苷超声心动图试验检测急性心肌梗死后患者存活心肌

目的 评价小剂量腺苷超声心动图试验(LDAE)对急性心肌梗死早期存活心肌检出的准确性.方法 对36例急性心肌梗死患者于发病后3～10 d行剂量递增的LDAE(腺苷80、100和110μg·kg-1·min),所有患者在LDAE前后接受经皮冠状动脉介入术.采用17节段半定量分析法分析二维超声图像.心肌梗死后2～3个月随访二维超声,以局部室壁运动改善作为心肌存活标准,评价LDAE检测存活心肌的敏感性、特异性和小剂量腺苷对血液动力学的影响.结果 腺苷110μg·kg·min时与用药前比较,心率轻度增快(78.1±10.9)次/min比(70.7±10.8)次/min,P<0.01],左室收缩末期容积减小(20.1±9.3)ml比(30.4±1.9)ml,P<0.01]和射血分数升高(74.7%±9.8%比62.6%±10.4%,P<0.01).腺苷不良反应总发生率38.9%(14/36),但症状轻微.LDAE检出存活心肌的敏感性、特异性、诊断准确性、阳性预测值和阴性预测值分别为90.3%、80.8%、86.0%、84.8%和87.5%.腺苷剂量100μg·kg·min时敏感性(88.5%)和特异性(86.0%)好而不良反应无明显增加.结论 LDAE是检测急性心肌梗死后患者存活心肌的较好而安全的新方法 ,有较高的敏感性和特异性,腺苷剂量100μg·kg·min可作为LDAE进一步研究的推荐剂量.

Low-dose adenosine echocardiography for detection of myocardial viability in patients with acute myocardial infarction

Objective To evaluate the value of low-dose adenosine echocardiography (LDAE) for detection of myocardial viability in patients with acute myocardial infarction (MI). Methods Thirty-six patients underwent LDAE within 3-10 days after onset of first acute MI before (n=4) or after (n=32) percutancous coronary intervention. A 17-segment semi-quantitative scoring model was adopted. Wall motion improvement derived from two dimensional images at follow-up (2-3 months after acute MI ) comparing baseline before adenosine infusion was used as gold criteria for myocardial viability. Results Low-dose adenosine slightly increased heart rates (70.7±10.8)beats/min vs. (78.1±10.9)beats/min ,P<0.01] and also significantly reduced left ventrieular endsystolic volume (30.4±1.9) ml vs. (20.1±9.3) ml, P<0.01] and increased ejection fraction (62.6%±10.4% vs. 74.7%±9.8%,P<0.01). The sensitivity, specificity, diagnostic accuracy, positive and negative prective values of LDAE for identification of viable myocardium were 90.3%, 80.8% ,86.0%, 84.8% and 87.5%, respectively. Incidence of mild terms of balanced sensitivity and specificity for detecting viable myocardium without increasing the adverse and specificity for detecting viable myocardium in acute MI with only minimal adverse effects.