心肌造影超声心动图与低剂量多巴酚丁胺负荷超声心动图识别心肌梗死后患者存活心肌的对比研究  

Assessment of Myocardial Viability in Patients with Post myocardial Infaction:Comparison of Myocardial Contrast Echocardiography and Low Dose Dobutamine Echocardiography

作　　者：仲肇舒 孔繁荣 张新琳 朱正明 

出　　处：《中国超声医学杂志》2001年第4期266-269,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :比较心肌造影超声心动图 ( MCE)与低剂量多巴酚丁胺负荷超声心动图 ( L DDSE)评价 2 5例心肌梗死后患者心肌存活性。方法 :MCE采用谐频频率 1.8～ 3.6 MHz的能量多普勒模式 ,按 1:4的比例于收缩末期触发的方式提取图像。利声显浓度为 30 0 mg/ml,采用微量输液泵于患者左肘静脉内持续输注 4分钟 ( 2 ml/min) ,MCE心肌灌注结果进行半定量评价 :0为无显影作用 ,0 .5为部分或不均匀显影作用 ,1为完全及均匀显影作用 ;MCE定义心肌存活性为显影作用≥ 0 .5分 ,无显影作用表示无心肌存活性。 L DDSE输注剂量分别为 5、10、2 0μg/kg/min,每期3min,采用 16节段划分法对每个节段的心肌搏幅进行记分∶正常运动 =1分 ,低动力 =2分 ,无动力 =3分 ,矛盾运动=4分。L DDSE时计分减少≥ 1分定义为有收缩功能储备。结果 :( 1) MCE前后及 L DDSE前与 5、10 μg/( kg/min) ,患者血压和心率改变无明显差异 ;( 2 )总共 44个梗死节段中 ,MCE评价存活为 2 8节段 ,不存活为 16节段 ,L DDSE评价存活为 2 3节段 ,不存活 19节段 (与 MCE相比 ,L DDSE的敏感性与特异性为 92 %、84% ) ;( 3) MCE与 L DDSE评价心肌存活性的观察一致率为 87% ( Kappa:0 .77)。结论 :MCE与 LObjective:To evaluate myocardial viability in post myocardial infaction patients with myocardial contrast echocardiography(MCE) and low dose dobutamine echocardiography(LDDSE).Methods:Twenty five post myocardial infaction patients (mean age 67±7 years, 21 males) were studied. MCE was performed with a HP Sonos 5500 during intravenous infusion Levovist (300mg/ml, 2ml/min) using harmonic power Doppler mode.. The imaging was acquired during end systolic triggering at intervals of 1:4 beats. Using a 16 segment model, myocardial perfusion both in gray and power Doppler was scored as 0(contrast deficit), 0.5(partial and non homogenous contrast), 1(complete and homogenous contrast), presence of viability was defined as the presence of contrast effect (score ≥0 5). LDDSE was performed after MCE, stages were ≥3 minutes in duration. The stages were low dose (5 and 10 μg/kg/min) and 20 μg/kg/min, wall motion analysis (16 segment model) was performed. Myocardial viability was defined as presence contractile reserve (CR) by LDDSE. Results:(1)Compared with baseline, heart rate and blood pressure were no significant changes after MCE and LDDSE.(2)A total of 150 segments, 44 were asynergic, (5 hypokinetic and 39 akinetic and dyskinetic). MCE score ≥0 5 were 28,MCE score =0 were 16. For CR in LDDSE were 23, no CR were 21. (3) For LDDSE/MCE, sensitivity, specificity, positive predictive value, negative predictive value, accuracy were 92%,84%,88%,89% and 87%,respectively.Kappa value was 0 77.Conclusions:The results obtained with LDDSE appear to be closer with those of MCE, LDDSE and MCE are useful in identifying myocardial viability in patients with post myocardial infaction.

关 键 词：心肌造影超声心动图 低剂量多酚丁胺负荷超声心动图 心肌存活性 心肌梗死 

分 类 号：R445.1[医药卫生—影像医学与核医学]