声学造影结合腺苷试验检测存活心肌的研究  

Assessment of myocardial viability by real-time myocardial contrast echocardiography combined with adenosine stress echocardiography

作　　者：李超 巩雷[2] 郝骥[2] 冯建启[2] 祁春梅[2] 武维恒[2] 彭城[2] 

机构地区：[1]江苏省徐州电力医院心血管内科,221000 [2]江苏省徐州医学院第二附属医院心血管内科,221006

出　　处：《中华全科医学》2014年第7期1120-1122,共3页Chinese Journal of General Practice

摘　　要：目的探讨在小剂量腺苷负荷(LDASE)状态下实时心肌声学造影(RT-MCE)检测冠心病患者存活心肌的临床价值。方法 35例经超声心动图检查存在左室室壁节段性运动异常和左室收缩功能障碍(左室射血分数<50%)的冠心病患者,经皮冠状动脉介入治疗(PCI)之前进行RT-MCE联合LDASE的检查。所有患者在RT-MCE联合LDASE的检查后1周内进行PCI。应用美国心脏协会(American Heart Association,AHA)推荐的左室17节段分法获得异常节段显影,图像采用目测半定量法。术后1、3、6个月时分别复查超声心动图,PCI术后室壁运动改善作为判定存活心肌的金标准。结果 RT-MCE目测半定量法检测存活心肌的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为70.7%、70.6%、70.7%、73.1%和68.1%;RT-MCE联合LDASE目测半定量法检测存活心肌的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为82.1%、84.4%、83.2%、85.6%和80.7%均较RT-MCE有统计学差异(χ2=4.42、5.92、10.22、5.63和4.71;P均<0.05)。结论 RT-MCE在检测存活心肌方面具有一定的临床价值,RT-MCE联合LDASE可显著提高其临床价值。Objective To explore the significance and value of real-time myocardial contrast echocardiography（ RT-MCE） combined with low-dose adenosine stress echocardiography（ LDASE） for evaluation of viable myocardium in the patients with coronary artery disease（ CAD）. Methods Thirty-five hospitalized patients with regional wall motion abnormalities（ RWMA） and left ventricular systolic dysfunction（ left ventricular ejection fraction 50%） were included in our study. Before undergoing the percutaneous coronary intervention（ PCI）,all of them were examined by RT-MCE combined LDASE by Philips iE33. Every segment image was acquired and evaluated by according to 17-segment model of American Heart Association. PCI was performed within one week after RT-MCE combined LDASE in all patients. The images of RT-MCE were semi-quantitatively analyzed. The movement of each segment was observed by routine echocardiography after 1,3,6 months of PCI,and the presence of improvement was taken as a gold standard of viable myocardium. Results The sensitivity,specificity,accuracy,positive predict value and negative predict value of RT-MCE for assessment of viable myocardium were 70. 7%,70. 6%,70. 7%,73. 1% and 68. 1%,respectively. Compared those of RT-MCE combined LDASE to RT-MCE,the difference were significant,rising to 82. 1%,84. 4%,83. 2%,85. 6% and 80. 7%,respectively（ χ^2= 4. 42, 5. 92,10. 22,5. 63 and 4. 71; all P〈0. 05）. Conclusion The clinical value of RT-MCE in the assessment of viable myocardium is sure; RT-MCE combined with LDASE should improve significantly its clinical utility.

关 键 词：心肌声学造影 小剂量腺苷负荷试验 冠心病 存活心肌 

分 类 号：R540.49[医药卫生—心血管疾病] R445.9[医药卫生—内科学]