超声实时心肌造影对X综合征心肌微循环的定量评价  

Quantitative Assessment of Myocardial Microcirculation in Cardiac Syndrome X Using Real-time Myocardial Contrast Echocardiography

作　　者：肖杨杰[1] 任卫东[1] 乔伟[1] 毕文静[1] 孙志军[2] 刘双双[2] 

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004 [2]中国医科大学附属盛京医院心内科,辽宁沈阳110004

出　　处：《中国医学影像学杂志》2014年第6期401-404,共4页Chinese Journal of Medical Imaging

基　　金：辽宁省科技厅科学技术计划项目(2011225015);中国医科大学"十二五"第二批医学教育科学研究项目(YDJK2012039)

摘　　要：目的探讨心肌造影超声心动图(MCE)定量评价心脏X综合征(CSX)患者心肌微循环灌注的价值。资料与方法选择19例CSX患者作为CSX组,12例健康志愿者作为对照组。分别行超声心动图及MCE检查,测量并记录受检者的二尖瓣口舒张期血流峰速(E)、舒张末期血流峰速(A)、E波速度下降时间(EDT)、舒张末期左心室内径(LVEDD)、收缩末期左心室内径(LVESD)、左心室射血分数(LVEF)、收缩期运动速度(S')、收缩早期运动速度(E')、舒张晚期运动速度(A');注入造影剂,记录注入造影剂后心尖位三切面及左心室短轴基底、中间、心尖节段闪烁显像前5个心动周期的动态图像,以及闪烁显像后15个心动周期的动态图像。应用QLab 8.1软件对存储图像进行分析,获得曲线峰值强度(A*)、曲线斜率(β),计算心肌血流量(MBF)。结果与对照组相比,CSX组E值、E/A值、E'峰速值减小,差异有统计学意义(t=-3.08、-2.29、-2.36,P<0.05),CSX组EDT延长、E/E'值增大,差异有统计学意义(t=2.33、2.24,P<0.05)。两组LVEDD、LVESD、LVEF值、A值、S'、A'峰速值差异无统计学意义(t=0.89、0.57、0.33、1.24、-1.17、0.77,P>0.05),CSX组A*、β、MBF降低,差异有统计学意义(t=4.32、-3.75、-3.69,P<0.05)。结论 CSX患者存在微血管灌注异常,MCE可以定量评价CSX患者的心肌微循环灌注异常。Purpose To explore the application value of real-time myocardial contrast echocardiography（MCE） for quantitative assessment of myocardial microcirculation in patients with cardiac syndrome X（CSX）.Materials and Methods Nineteen patients with CSX and 12 healthy volunteers were enrolled,each of them underwent both echocardiography and real-time MCE examination.Conventional systolic and diastolic parameters of the subjects were recorded and measured.After the injection of contrast agent,dynamic images of apical three facets position and left ventricular fractional base,middle and apical segments in 5 cardiac cycles before and 15 cardiac cycles after scintigraphy were recorded and reserved.QLab was applied to analyze the stored images,and peak contrast density（A＊）,myocardial blood flow rate（β） was obtained to calculate the myocardial blood flow（MBF）.Results Compared with the control group,E value,E/A value,and TDI mitral annulus interval E’ peak velocity decreased in CSX group,the difference was statistically significant（t=-3.08,-2.29 and-2.36,P＆lt;0.05）,EDT prolonged and E/E’ value increased in CSX group,the difference was also statistically significant（t=2.33 and 2.24,P＆lt;0.05）.No statistically significant difference（t=0.89,0.57,0.33,1.24,-1.17 and 0.77,P＆gt;0.05） was found for LVEDD,LVESD,LVEF values,A values,TDI mitral annulus interval S’ and A’ peak velocity between the two groups,A＊,β and MBF decreased in CSX group and the difference was statistically significant（t=4.32,-3.75 and-3.69,P＆lt;0.05）.Conclusion There are microvascular perfusion abnormalities in patients with CSX,and real-time myocardial contrast echocardiography can be used for the quantitative evaluation of myocardial microcirculation perfusion abnormalities in patients with CSX.

关 键 词：微血管性心绞痛 超声心动描记术 超声造影 微循环 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]