实时心肌超声造影检测冠状动脉慢性完全闭塞患者存活心肌  

Evaluation of viable myocardium in patients with chronic total coronary occlusion by real-time myocardial contrast echocardiography

作　　者：徐磊[1] 刘畅[1] 修春红[2] 刘宗泓[1] 肖喜刚[3] 沈景霞[2] 刘宏宇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心血管外科,150001 [2]哈尔滨医科大学附属第一医院心脏超声室,150001 [3]哈尔滨医科大学附属第一医院CT室,150001

出　　处：《中华胸心血管外科杂志》2013年第10期600-603,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：黑龙江省青年科技基金（Qc2012c093）

摘　　要：目的应用实时心肌超声造影（RTMCE）分析冠状动脉慢性完全闭塞（CTO）患者冠状动脉旁路移植术（CABG）前心肌微血管灌注状况，探讨有效检测存活心肌的方法，为CABG适应证的选择提供参考。方法27例CTO患者拟行CABG，术前1周行RTMCE检查，术后1年行超声心动图和冠状动脉256层螺旋cT血管成像随访。存活心肌定义为术后超声检查室壁运动明显改善≥1分。半定量分析超声造影图像，心肌存活定义为心肌灌注计分≤2分。利用患者操作特征曲线定量分析心肌血流量（MBF）检测存活心肌。结果CABG术后患者的左心室射血分数较术前显著增加（P〈0．01），259个室壁运动异常节段中，149个（58％）节段术后观察到室壁运动改善≥1分，认定为存活心肌，110个（42％）节段认定为非存活心肌，存活心肌节段的A、β、A×β值显著大于非存活心肌节段（P〈0．01）。与半定量分析相比，定量分析MBF增加了RTMCE检测存活心肌的敏感度（P〈0．05）。结论RTMCE较能准地确评估心肌存活状况，为临床决策、判断预后提供参考依据。Objective Analysis of myocardial microvascular perfusion in patients with chronic total coronary occlusion （CTO） who underwent a coronary artery bypass graft （CABG） use real-time myocardial contrast echocardiography （RTMCE） , to provide an effective method of detecting viable myocardium and a reference for the choice of CABG indications. Methods Twenty-seven patients with CTO underwent RTMCE 1 week before CABG, they underwent follow-up echoeardiography and cor- onary artery 256-slice muhislice computed tomography angiography 1 year after CABG. Myocardial viability was defined as a postoperative ultrasound wall motion significantly improved ≥ 1 point. Semi-quantitative analysis of contrast images, myocardial viability was defined as myocardial perfusion score ≤ 2 points. Viable myocardium by quantitative assessment of myocardial blood flow （MBF） was determined by analyses of receiver-operating characteristic （ROC） curves. Results Patients with LVEF increased significantly after CABG （P 〈0.01 ） , Of 259 segments with wall motion abnormality, 149 （58%） showed wall motion significantly improved ≥1 point after CABG, considered viable myocardium, 110 （42%） were not observed in wall motion improved, considered to be non-viable. The viable myocardial segments were significantly greater than non-viable myocardial segments in A, β, A × β value （ P 〈 0.01 ）. Compared with the semi-quantitative analysis, quantitative analysis of MBF increased the sensitivity and accuracy of RTMCE for detecting viable myocardium （ P 〈 0. 05 ）. Conclusion RTMCE could accurately assess myocardial viability and provide a strong reference for clinical decision making and judging prognosis.

关 键 词：冠状动脉硬化 心肌 冠状动脉旁路移植术 非体外循环 心血管造影术 实时心肌超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]