腺苷负荷超声下定量组织速度成像和组织追踪技术检测老年心肌梗死患者存活心肌的研究  

Study of viable myocardium by quantitative tissue velocity imaging and tissue tracking under adenosine stress echocardiography in the elder patients with myocardial infarction

作　　者：朱慧[1] 张平洋[1] 方玲玲[1] 马小五[1] 冉虹[1] 王冲[1] 冯王飞[1] 

机构地区：[1]南京医科大学附属南京第一医院心血管超声科,210006

出　　处：《中华医学超声杂志（电子版）》2011年第2期20-22,共3页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：江苏省卫生厅科教兴卫工程开放课题(KF2009153)

摘　　要：目的探讨运用定量组织速度成像(QTVI)和组织追踪(TT)技术结合腺苷负荷超声心动图试验评价心肌存活的新方法。方法采用QTVI及TT检测36例老年陈旧性心肌梗死患者静息状态和腺苷(140μg·kg-1·min-1持续6min)作用下各节段收缩期峰值运动速度(Vs)、等容收缩期峰值运动速度(Vivc)以及收缩期最大位移(Ds)。以核素心肌灌注、代谢显像结果作为金标准将各节段划分为存活心肌组及非存活心肌组,分析QTVI及TT评定存活心肌的敏感度和特异度。结果基础状态下存活组与非存活心肌组之间Vs、Vivc、Ds差异无统计学意义(P>0.05)。腺苷作用下存活心肌组心肌Vs、Ds升高(P<0.05),而Vivc无明显变化(P>0.05)。腺苷作用下非存活心肌各项指标均无明显变化(P>0.05)。ROC曲线判定,以存活心肌腺苷负荷后△Vs(%)≥16.5作为截断值,则QTVI结合腺苷药物超声心动图识别存活心肌的敏感度和特异度分别为92.8%、78.8%;以存活心肌组心肌腺苷负荷后△Ds(%)≥18.5作为截断值,则TT结合腺苷药物超声心动图识别存活心肌的敏感度和特异度分别为91.1%、76.9%。联合运用△Vs%和△Ds%两项指标,检测心肌存活的敏感度和特异度分别为89.3%、88.5%。结论 QTVI及TT结合腺苷药物超声心动图能够为识别存活心肌提供可靠新方法。Objective To explore a new method to evaluate myocardial viability with quantitative tissue velocity imaging (QTVI) and tissue tracking (TT) combined with adenosine stress echocardiography. Methods The peak systolic velocity (Vs),isovolumic contraction peak velocity (Vivc) and the maximum systolic displacement (Ds) of each segment were detected using TT with QTVI in 36 cases of elderly patients with myocardial infarction at rest and adenosine (140 μg·kg-1·min-1) was administered for 6 minutes. Every segment was defined as viable or non-viable myocardium according to radionuclide myocardial perfusion / metabolic imaging. Then the sensitivity and specificity of assessment of viable myocardium with QTVI and TT combined with adenosine stress were studied by echocardiography. Results There was no significant difference in Vs,Vivc and Ds at rest between viable group and non-viable myocardial group. Although Vivc had no significant change (P>0.05),Vs and Ds were increased (P<0.05) after adenosine administration in viable group while no significant change in all variables was found in non-viable group(P>0.05). From the ROC curve,the cut-off value of △Vs(%)≥16.5 after adenosine by echocardiography had a high sensitivity (92.8%) and specificity (78.8%) in identifying viable myocardium. △Ds (%)≥18.5 after adenosine by echocardiography had a better sensitivity (91.1%) and specificity (76.9%) in identifying viable myocardium. Combining these two indicators to detect myocardial viability,the sensitivity and specificity were 89.3% and 88.5%,respectively. Conclusion The QTVI and TT combined with adenosine by echocardiography could provide a reliable and new method for identifying viable myocardium.

关 键 词：超声心动描记术 定量组织速度成像 组织追踪 腺苷 存活心肌 

分 类 号：R542.22[医药卫生—心血管疾病]