实时心肌超声造影微泡再充盈参数评价心肌梗死患者心肌灌注  

Assessment of myocardial perfusion by the microbubble replenishment parameters of real-time myocardial contrast echocardiography

作　　者：黎鹏[1] 赵博文[1] 邓又斌[2] 杨好意[2] 毕小军[2] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,杭州310016 [2]华中科技大学同济医学院附属同济医院超声影像科

出　　处：《中华超声影像学杂志》2011年第12期1021-1024,共4页Chinese Journal of Ultrasonography

摘　　要：目的 应用实时心肌超声造影分析收缩末期与舒张末期再充盈参数,探讨其评价心肌梗死患者心肌微循环灌注的可行性.方法 对21例陈旧性心肌梗死及急性心肌梗死亚急性期的患者及6例正常对照组进行实时心肌超声造影.用时间强度曲线分析左室各节段收缩末期及舒张末期的微气泡再充盈过程.根据灌注的函数公式y（t）=A[1 - e-kt]＋B,脱机心电图触发方式选择收缩末期（T波结束）帧和舒张末期（R波顶点）帧分别执行灌注曲线拟合,得到微气泡信号强度增加的高度（A值）、信号强度增加的速率（k值）并计算A×k值,比较收缩末期与舒张末期相应节段心肌血容量、心肌血流速度、心肌血流量的差异.结果 正常对照组中收缩末期的A值、k值及A×k值均小于舒张末期各值,差异有统计学意义[分别为（6.21±2.69）dB对（7.93±3.66）dB,P＜0.05；0.36±0.15对0.42±0.19,P＜0.01；2.88±1.29对3.39±1.61,P＜0.05].与收缩末期相比,舒张末期A值,k值及A×k值具有更大的变异性（变异系数分别为A值46.2％对43.3％,k值45.2％对41.4％,A×k值47.5％对44.8％,P值均＜0.05）.病例组中梗死相关冠状动脉供血节段心肌的收缩末期再充盈参数明显小于非梗死冠状动脉供血心肌各参数值,差异有统计学意义[A值、k值及A×k值分别为（3.99±1.02） dB对（4.77±1.24）dB,P＜0.05；0.31±0.13对0.35±0.16,P＜0.05;1.25±0.74对2.39±1.11,P＜0.01].结论 收缩末期与舒张末期再充盈参数可以评价心肌微循环灌注,收缩末期各参数值具有更小的变异性,其中收缩末期k值是一个较好的评价指标.然而,显著的变异性提示这些指标适用于自身前后对照研究.Objective To assess myocardial perfusion by the end-systolic and end-diastolic replenishment parameters of real-time myocardial contrast echocardiography （MCE）.Methods Twenty-one patients with myocardial infarction（MI） and normal control group of 6 cases underwent intravenous realtime myocardial contrast echocardiography via slow and homogeneous venous injections of SonoVue.MCE images were obtained from the apical 4-chamber,2-chamber,and long-axis views.According to the exponential function：y（t） =A [1 - e-kt] ＋ B,the time intensity curves were obtained.By an off-line ECG triggering and curve fitting,the replenishment parameters A value,k value,A × k value were obtained separately from end-systolic and end-diastolic images.Results In normal control group,the end-systolic replenishment parameters A value,k value,A × k value were all lower than that of the end-diastolic replenishment parameters[（6.21 ± 2.69）dB vs （7.93 ± 3.66）dB,P 〈0.05;0.36 ± 0.15 vs 0.42 ± 0.19,P 〈 0.01 ;2.88 ± 1.29 vs 3.39 ± 1.61,P 〈0.05,respectively].The end-diastolic replenishment parameters were found significantly greater variability than the end-systolic values （variation coefficient CV：A value 46.2% vs 43.3%,k value 45.2% vs 41.4%,A× k value 47.5% vs 44.8%,all P 〈0.05）.In 21 patients,the end-systolic replenishment parameters in myocardial segments supplied by infarct-related coronary artery were significantly lower than that in myocardial segments supplied by non - infarct - related coronary artery.Conclusions The end-systolic and end-diastolic replenishment parameters of real time myocardial contrast echocardiography can assess myocardial perfusion.The variability of the end-systolic replenishment parameters is smaller than that of the end diastolic parameters.Significant variability in k-value suggests that this parameter is best suited for before-after study in the same patient.

关 键 词：超声心动描记术 心肌梗死 心肌再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]