在负荷多巴酚丁胺超声心动图中T波假正常化预测血管重建术后存活心肌  

Identification of viable myocardium by T-wave normalization and functional improvement during low-dose dobutamine testing in Q wave myocardium infarction after revascularization

作　　者：李宪伦[1] 王勇[1] 张小平[1] 郑知刚[1] 钱端[1] 曾玉杰[1] 秦延丽[1] 崔超英[1] 柯元南[1] 

机构地区：[1]北京中日友好医院心内科,100029

出　　处：《临床心电学杂志》2004年第3期196-199,共4页Journal of Clinical Electrocardiology

摘　　要：目的在负荷多巴酚丁胺超声心动图试验中,评估T波假正常化及收缩储备对存活心肌的检测价值。方法41例近期心肌梗死患者,于血管重建术前行低剂量多巴酚丁胺超声心动图(Low-DoseDobutamineEchocardiography,LDDE)和负荷心电图检查,术后两个月重复静息超声心动图检查。采用16节段和4分法评估左室功能,在术前和术后随访时有1个或1个以上梗死节段室壁运动评分≥1为功能改善;T波的假正常化的定义为在≥2个梗死相关的心电图导联上T波由倒置变为直立。结果术后对所有心肌梗死患者进行了随访,其中有22例(54%)室壁运动改善,术前负荷超声心动图与负荷心电图总的符和率为71%,T波假正常化预测术后室壁运动改善的敏感性和特异性分别为77%和79%;LDDE预测术后室壁运动改善的敏感性和特异性分别为82%和84%;两种方法共同预测术后室壁运动改善的敏感性和特异性分别为64%和95%。结论负荷试验中T波假正常化和LDDE均是检测存活心肌安全、易行及有价值的方法。Objective To evaluate the clinical value of T-wave normalization and contractile reserve in detecting viable myocardium in infarct-related area during low-dose dobutamine testing. Methods Forty-one patients(52.3 ± 9.8 years )with Q wave myocardial infarction underwent low-dose dobutamine electrocardiography and echocardiography before revascularization, revascularization was performed in all patients. Resting echocardiogram was repeated two month after revascularization. A score model based on 16 segments and four grades was used to assess left ventricular function. Functional improvement was defined as a reduction of wall motion score ≥1 in ≥1 segments at follow up. Dobutamine-induced T-wave normalization was defined as negative T waves becoming upright in ≥2 infarct-related ECG leads. Results In 41 patients a rest echocardiograms was obtained after 2 months of revascularization, Late functional improvement occurred in 22 patients(54%), The overall agreement between echocardiography and electrocardiography was 71%,the T-wave normalization elevation showed a sensitivity and a specficity of 77 % and 79% for predicting late recovery of function,respectively;LDDE demonstrated a sensitivity and a specficity of 82% and 84%, respectively; when the two methods were considered, the sensitivity and specficity were 64% and 95%, respectively. Conclusions T-wave normalization and contractile reserve are a valuable marker of myocardial viability. when the two methods were considered, gave a better specificity.

关 键 词：T波 术后 室壁运动 存活心肌 超声心动图 心电图 多巴酚丁胺 血管重建术 术前 梗死 

分 类 号：R542.22[医药卫生—心血管疾病]