二维应变超声心动图结合实时心肌超声造影评价冠状动脉不同狭窄程度对心肌灌注和心功能的影响  

Impact of different graded coronary stenosis on myocardial perfusion and function by two-dimensional strain echocardiography combined with myocardial contrast echocardiography

作　　者：李燕[1] 吕清[1] 王静[1] 张艳容[1] 陈明[1] 张静[1] 方凌云[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科,武汉430030

出　　处：《中华超声影像学杂志》2009年第2期118-121,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（30872422）

摘　　要：目的应用二维应变超声心动图（2D-Strain）结合实时心肌超声造影（MCE）评价静息状态下冠状动脉（冠脉）不同程度狭窄患者局部心肌血流灌注和应变的变化及两者之间的关系。方法对25例冠心病患者及15例健康志愿者行MCE和2D-Strain检查。血供异常的心肌节段按供血冠脉狭窄程度分为轻度狭窄组（50％～75％）、中度狭窄组（76％～89％）和重度狭窄组（≥90％）。从MCE再灌注充盈曲线获得A值和8值分析心肌灌注；应用2D-Strain测量心肌纵向收缩期峰值应变（SL）分析心功能。结果在异常冠脉供血区，随着冠脉狭窄程度的加重；各组的A值与对照组相比呈递减趋势，但差异无统计意义（P〉0．05）；而中度狭窄组和重度狭窄组的B值和SL值均显著低于对照组（B值：0．75±0．67和0．67±0．53对0．97±0．65；SL值：11．60±5．89和9．58±6．51对19．46±6．17，均P〈0．05）。8值与SI。值有相关性（r=0．65，P〈0．05）。结论MCE的再灌注参数口值和2D-Strain测量的SL值均可发现静息状态下〉75％的冠脉狭窄引起的心肌缺血，且两者具有较好的相关性。Objective To estimate the impact of various extent of coronary stenosis at rest on myocardial perfusion and functional indices from myocardial contrast echocardiography（MCE） and two- dimensional strain echocardiography（2D-Strain） and characterize the relationship between them. Methods Three levels of coronary stenosis：mild （50%-75%）,moderate （76%-89%）,severe （≥90%） in 25 patients with coronary artery stenosis and 15 healthy subjects in the control group were examined. Plateau videointensity （value A） and time to plateau （value β） of the replenishment curve from MCE were calculated for perfusion analysis, and longitudinal peak systolic strain（SL） from 2D-Strain were measured for functional analysis. Results Value A tended to decrease with increasing severity of stenosis,although these differences did not reach the level of statistical significance, β and SL were significantly increased in the context of moderate and severe coronary stenosis when compared with control group （β,moderate 0. 75 ±0. 67 and severe0.67±0.53 vs normal 0.97± 0. 65 ; SL, moderate 11.60± 5.89 and severe 9.58 ± 6.51 vs normal 19.46± 6.17, P 〈0. 05, respectively）. β was positively correlated with SL （r = 0.65, P 〈0.05）. Conclusions β of the replenishment curve from MCE and SL from 2D-Strain both can detect greater than 75 % coronary stenosis inducing myocardial ischemia,and they had good correlation.

关 键 词：超声心动描记术 微气泡 冠状动脉狭窄 心室功能 

分 类 号：R686[医药卫生—骨科学]