二维斑点追踪技术结合腺苷负荷评价心肌存活性  

Viable myocardium evaluation by two dimensional speckle tracking imaging combined with adenosine stress echocardiography

作　　者：冉红[1] 张平洋[1] 方玲玲[1] 马小五[1] 吴文芳[1] 冯王飞[1] 

机构地区：[1]南京医科大学附属南京医院心血管超声科,南京210006

出　　处：《中华心血管病杂志》2013年第1期28-32,共5页Chinese Journal of Cardiology

基　　金：江苏省卫生厅科教兴卫工程开放课题（KF2009153）;南京市卫生青年人才项目

摘　　要：目的探讨二维斑点追踪成像技术结合腺苷负荷超声心动图评价心肌存活性的临床价值。方法应用二维超声心动图观察39例心肌梗死患者心肌运动，二维斑点追踪成像技术分别检测患者静息状态和腺苷负荷（140μg·kg～·min^-1）作用下各节段径向、纵向及环向收缩期峰值应变（RSpeak-sys、LSpeak-sys、CSpeak-sys），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组及非存活组心肌。结果（1）总共624心肌节段中，368节段表现为运动异常，其中存活心肌215节段，非存活心肌153节段。（2）静息状态下，存活与非存活心肌组间各指标差异均无统计学意义；腺苷负荷后，存活组的RSpeak-sys[（37．98±5．45）％比（30．22±5．47）％]及LSpeak-sys[（-23．71±4．53）％比（-17．52±4．34）％]较其静息状态下明显增加（P〈0．05），而非存活组各指标变化差异无统计学意义（P〉0．05）；存活组与非存活组的Rs。aku。[分别为（37．98±5．45）％和（30．12±5．37）％]、LSpeak-sys[分别为（-23．71±4．53）％和（-16．95±4．62）％]变化差异有统计学意义（P〈0．05），而CSpeak-sys变化差异无统计学意义（P〉0．05）。（3）以RSpeak-sys、LSpeak-sys作为观察对象，腺苷负荷状态下RSpeak-sys增加〉9．8％评价存活心肌的敏感度为82．3％，特异度为81．1％；LSpeak-sys增加〉16．5％评判存活心肌的敏感度为83．5％，特异度为92．3％。结论二维斑点追踪成像技术结合腺苷负荷超声心动图能够为临床提供有效区分存活与非存活心肌的新途径。Objective Regional left ventricular （LV） function could be detected by measuring peak-systolic strain by speckle tracking imaging （STI）. We evaluated the value of STI combined with adenosine stress echocardiography on assessing myocardial viability in patients with myocardial infarction （MI）. Methods Two dimensional echocardiography was performed at rest and after adenosine stress echocardiography （infused at 140 μg · kg^-1 · min^-1 over a period of 6 rain ） in 39 stable patients with previous MI. Peak-systolic （Speak-sys ） circumferential strain, radial strain and longitudinal strain were assessed by STI. Radionuclide myocardial perfusion/metabolic imaging served as the ＂gold standard＂ to detection of myocardial viability. Results （ 1 ） There were 215 viable and 153 non-viable regions among 368 abnormal motion segments out of 624 segments in 39 MI patients according to radionuclide imaging results. （ 2 ） Speak_sys was similar between viable and nonviable myocardium at rest （ all P 〉 0. 05 ）. After adenosine infusion, radial Speak-sys [ （ 37.98 ± 5.45 ） % vs. （ 30.22 ± 5.47 ） % ], longitudinal Speak-sys [ （ - 23.71 ± 4. 53 ） % vs. （ - 17.52 ± 4. 34 ） % ] increased significantly （ P 〈 0. 05 ） in viable segments compared to baseline levels and were significantly higher than in nonviable segments radial Speak-sys [ （ 37. 98 ± 5. 45 ） % VS. （30. 12±5.37）%] and longitudinal Speak-sys[（ -23.71 ±4.53）% vs. （ -16.95 ±4.62）%]（P〈 0. 05）, while remained unchanged in nonviable segments before and after adenosine infusion. Circumferential Speak-sys was similar before and after adenosine infusion in both viable and nonviable segments （ all P 〉 0. 05 ）. （ 3 ） Delta radial strain change 〉 9.8% has a sensitivity of 82.3% and a specificity of 81, 1% whereas a delta change of longitudinal strain 〉 16. 5% has a sensitivity of 83, 5% and a specificity of 92. 3% for detecting viable segments. Conclusions Speckle tracking imaging

关 键 词：心肌梗死 超声心动描记术 放射性核素显像 细胞存活 

分 类 号：R542.22[医药卫生—心血管疾病]