定量实时心肌声学造影结合小剂量多巴酚丁胺负荷检测存活心肌

目的评价定量实时心肌声学造影（RT-MCE）联合小剂量多巴酚丁胺负荷超声心动图（LD-DSE）检测存活心肌的临床价值。方法22例经彩色超声检查存在左心室壁节段运动障碍的冠心病患者，进行RT-MCE、RT-MCE联合LD-DSE、冠状动脉造影（CAG）及介入治疗（PCI），所有狭窄病变均行完全血运重建。RT-MCE图像按美国心脏超声协会16节段划分法获得各运动异常节段心肌灌注显影，用QLab软件定量分析法求出各节段的p值及A·p值。术后1、3、6个月时分别复查心脏超声，以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果普通RT-MCE各节段A值以3.78、β值以0.38和A·β值以1.39为截断点，诊断存活心肌的灵敏度、特异度及准确度分别是70.2％、68.5％、70.2％和87.4％、78.9％、83.1％及80.6％、89.5％、83.8％；联合LD-DSE后，各节段A值以3.84、β值以0.49和A·β值以1.74为截断点，诊断存活心肌的灵敏度、特异度及准确度分别是72.4％、67.8％、71.2％和87.4％、89.5％、88.1％及90.3％、82.5％、86.2％。联合LD-DSE后，RT-MCE β值定量法检测存活心肌的特异度和A·β值定量法检测存活心肌的灵敏度均有明显提高（89.5％ vs 78.9％；90.3％ vs 80.6％，P值均〈0.05）。结论RT-MCE β值及A·β值定量分析法检测存活心肌有较高的临床价值，联合小剂量多巴酚丁胺负荷可提高其检测价值。

Value of quantitative real-time myocardial contrast echocardiography in the assessment of viable myocardium

Objective To evaluate the value of quantitative real-time myocardial contrast echocar-diography （RT-MCE） in the detection of viable myocardium. Methods A total of 22 patients with regional wall motion abnormalities（RWMA） according to routine echocardiography took RT-MCE, RT-MCE combined with low dose dobutamine echocardiography（LD-DSE）, coronary angiography and percutaneous coronary intervention（PCI）. Every segment image was achieved and evaluated according to 16-segment model of American Society of Echocardiography. The motion of every segment was observed by echocardiography after 1,3 and 6 months. The gold standard is the recovery of ventricular segment after PCI. The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the QLab software. Results The sensitivity ,specificity and accuracy of RT-MCE in detecting viable myocardium were 70.2% ,68.5% ,70.2% and 87.4% ,78.9% ,83.1% and 80.6% ,89.5% ,83.8% respectively in case A was 3.78 and β was 0.38 and A·β was 1.39 as a cut off point;The sensitivity,specificity and accuracy of RT-MCE with LD-DSE in detecting viable myocardium were 72.4% ,67.8% ,71.2% and 87.4% , 89.5% ,88.1% and 90.3% ,82.5% ,86.2% respectively in case A was 3.84 and β was 0.49 and A·β was 1.74 as a cut off point. The specificity of β quantitative RT-MCE （ 89.5 % vs 78.9%, P 〈 0.05 ） and the sensitivity of A·β quantitative RT-MCE increased（90.3% vs 80.6% , P 〈 0.05）in detecting viable myocardium when combined with LD-DSE. ConcLusion RT-MCE can be used as a valuable method to detect viable myocardium and the value of recovery combined with LD-DSE.