小剂量多巴酚丁胺试验中定量组织速度成像技术检测存活心肌的研究  

Detection of viable myocardium by using quantiative tissue velocity imaging in low dose dobutamine stress test

作　　者：陈金玲[1] 郭瑞强[1] 周青[1] 郝力丹[1] 黄从新[1] 

机构地区：[1]武汉大学人民医院超声影像科,430060

出　　处：《中华超声影像学杂志》2006年第7期485-488,共4页Chinese Journal of Ultrasonography

基　　金：湖北省科技厅资助项目(2003AA301C02)

摘　　要：目的探讨定量组织速度成像技术（QTVI）在小剂量多巴酚丁胺负荷试验（LDDSE）中检测存活心肌的临床价值。方法25例陈旧性心肌梗死患者，分别于静息及5、10μg·kg^-1·min^-1多巴酚丁胺负荷下获取心尖两腔、四腔观清晰QTVI图像，测量等容收缩期峰值运动速度（VIVC）、收缩期峰值运动速度（VS）、等容收缩时间（TIVC）。经皮经腔冠状动脉成形术（PTCA）或PTCA＋支架术或冠状动脉旁路移植术（CABG）术后4～6周复查常规超声心动图。结果共研究200节段，正常组（72节段）、存活心肌组（77节段）和非存活心肌组（51节段）。静息下，与正常组比较，存活心肌组与非存活心肌组VIVC、VS均显著降低（P〈0．05），TIVC显著延长（P〈0．05），存活心肌组与非存活心肌组两组间VIVC、VS与TIVC则无显著差异。与静息下比较，5、10μg·kg^-1·min^-1多巴酚丁胺负荷下，存活心肌组VIVC、VS均显著增加（P〈0．05），TIVC显著缩短（P〈0．05）；而非存活心肌组VIVC、VS、TIVC则无显著变化。5μg·kg^-1·min^-1多巴酚丁胺负荷下，与VS比较，VIVC诊断存活心肌的敏感性、特异性均显著增加（P〈0．05）；10μg·kg^-1·min^-1负荷下，与VS比较，VIVC诊断存活心肌的敏感性、特异性差异无统计学意义。结论LDDSE中可运用QTVI技术无创检测存活心肌，QTVI指标VIVC、VS检测存活心肌均有较高的敏感性与特异性，但在5μg·kg^-1·min^-1多巴酚丁胺负荷下，VIVC具有更高的敏感性与特异性。Objective To detect viable myocardium in patients with old myocardial infarction（OMI） by using quantitative tissue velocity imaging（QTVI） in low dose dobutamine stress test（LDDSE）. Methods Twenty-five patients with OMI were accepted QTVI examination including 2-chamber, 4-chamber apical view. QTVI indices included peak velocity in isovolumic contraction （VIVC）, peak velocity in systolic（Vs） and time of isovolumic contraction （TIVc）. Results Two hundred segments were divided into the normal （group N, 72 segments）, viable myocardium （group V, 77 segments） and non-viable myocardium （ group NV, 51 segments）. At baseline, compared with group N, Vwc, Vs of group V and group NV decreased significantly（ P 〈0.05）, Two increased significantly（ P 〈0.05）. Compared with at baseline, Vs, Vwc of group V increased（ P 〈0.05） and Two decreased（ P 〈0.05） significantly at 5 and 10μg·kg^-1·min^-1; dobutamine stress; but there were no significant difference in group NV. At 5 μg·kg^-1·min^-1 dobutamine stress, compared with Vs, the sensitivity and specificity for diagnosis of viable myoeardium of Vwc increased significantly （P 〈 0.05）. At 10μg·kg^-1·min^-1dobutamine stress, there was no difference between the sensitivity and specificity for diagnosis of viable myocardium of Vwc and Vs. Conclusions In LDDSE, QTVI can distinguish viable myocardium invasive. Vs and Vwc both have high sensitivity and specificity to detect viable myocardium, however, Vwc has higher sensitivity and specificity in μg·kg^-1·min^-1 stress.

关 键 词：超声心动描记术 多巴酚丁胺 心肌梗塞 心肌再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]