实时三维超声心动图定量评价多巴酚丁胺对心肌顿抑犬和心肌梗死犬左室局部几何形状的作用  

Quantitative Assessment of Dobutamine Effects on Regional Left Ventricular Geometric Shapes of Stunned and Infarcted Canine Myocardium Using Real Time Three-dimensional Echocardiography

作　　者：王瑶[1] 王新房[2] 高长青[1] 谢明星[2] 吕清[2] 张跃力[2] 庄磊[2] 

机构地区：[1]解放军总医院心血管外科,北京市100853 [2]华中科技大学同济医学院附属协和医院超声影像科

出　　处：《中国超声医学杂志》2006年第9期647-650,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用实时三维超声心动图(RT-3DE)定量评价多巴酚丁胺对心肌顿抑犬和心肌梗死犬左室局部几何形状的作用。方法健康杂种犬32条,随机分为3组:心肌顿抑组(8条),心肌梗死组(16条),正常对照组(8条)。应用RT-3DE获取3组试验犬静息状态(Rest)及输注多巴酚丁胺(Dobutamine,Dob)10μg/(kg·min)的RT-3DE全容积数据库。脱机后进行后处理分析:采用心尖长轴观8平面法重建收缩末期左室立体几何形状。将二尖瓣环中点至左室心尖部心内膜最远点的连线定义为左室中心轴;将左室由心尖部至二尖瓣环等分成与中心轴垂直的10mm厚互相平行的短轴切面,从中选取室壁运动异常面积最大者作为研究平面。手动勾画所选研究平面收缩末期心内膜边界,测量其面积(A)和周长(C),计算Gibson圆形指数(CSI)(公式:CSI=4πA/C2),以此作为定量评价左室局部几何形状的指标。比较输注Dob前、后3组实验犬所选研究平面平均CSI的变化。结果(1)正常对照组静息状态下,所选研究平面平均CSI为0.971,接近于1;输注Dob后,平均CSI无明显变化(CSI=0.980,P>0.05);(2)心肌顿抑组静息状态下,所选研究平面平均CSI较正常对照组明显减小(CSI=0.950,P<0.05);输注Dob后,平均CSI明显增大(CSI=0.965,P<0.01),较正常对照组无明显差异(P>0.05);(3)心肌梗死组静息状态下,所选研究平面平均CSI较正常对照组也明显减小(CSI=0.931,P<0.001);输注Dob后,上述平均CSI明显增大(CSI=0.940,P<0.05),较正常对照组有明显差异(P<0.05)。结论通过应用RT-3DE分析输注Dob前、后左室局部几何形状的变化,可以区分心肌顿抑和心肌梗死。RT-3DE有望为临床定量评价左室局部几何形状提供一项有效手段。Objective To evaluate the dobutamine effects on regional left ventricular geometric shapes of stunned and infarcted myocardium in canine models using real time three-dimensional echocardiography. Methods Thirty-two anaesthetized dogs were divided randomly into three groups as follows ： 8 dogs were submitted to 15 min of coronary occlusion followed by 30 min of reperfusion （stunned model）, 16 dogs underwent 180 min of coronary occlusion followed by 30 min of reperfusion （infarct model） and 8 other dogs as the control group. A low infusion rate [5,10μg/ （kg · min）] Dobutamine eehoeardiography study were performed in the three groups. The duration of each step was 5 minutes. RT-3DE volume data sets were recorded at rest and at infusion rate of 10 μg/ （kg·min） .The acquired data sets were postprocessed off-line in Tom Tec 4D cardio-veiw RT 1.2 workstaticn. Regional left ventricular shapes were analyzed as follows.. （1） The acquired data sets were used to reconstitute octoplane projection which were used to reconstruct left ventricular （LV） shapes in the end-systole; （2） A center axis was constructed from the centroid of the mitral valve to the farthest point, in three-dimensional space of the reconstructed LV; （3） The reconstructed LV were dissected into 10 mm layers from the apex to the mitral valve annulus, perpendicular to the center axis. During this process, a plane that best represented the region of ischemia was identified on the basis of the greatest amount of wall motion abnormality （WMA）. The circular shape index （CSI） in the end-systole was caculated. These indices were used for analysis of the regional LV shape and geometry. Results （1） In the stunned model, at rest, the mean CSI was decreased significantly （CSI：0. 950, P〈0.05） .After Dob, the meanCSI （CSI=0.965, P〈0.05） was increased significantly, and at last reached to that of the control group （P〉0.05）.（2）In the infaret model,at rest ,the mean CSI（CSI=0.931,P〈0.01）was decr

关 键 词：三维超声心动描记术 实时显像 心肌顿抑 心肌梗死 心室解剖 多巴酚丁胺 

分 类 号：R542.22[医药卫生—心血管疾病]