实时心肌超声造影定量评价冠脉慢血流患者心肌血流灌注  

Quantitative analysis of myocardial perfusion in patients with coronary slow flow by real-time myocardial contrast echocardiography

作　　者：邢雨蒙 孔德红 陈永乐 史静 颜彦 陈海燕 舒先红 潘翠珍 Xing Yumeng;Kong Dehong;Chen Yongle;Shi Jing;Yah Yan;Chen Haiyan;Shu Xianhong;Pan Cuizhen(Department of Echocardiography, Zhongshan Hospital, Fudan University,Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032. Chin)

机构地区：[1]复旦大学附属中山医院上海市影像医学研究所上海市心血管病研究所心超室,上海200032 [2]复旦大学附属中山医院上海市影像医学研究所上海市心血管病研究所心内科,上海200032

出　　处：《中华超声影像学杂志》2018年第4期277-281,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81701694）;上海市科学技术委员会资助项目（16441908100）

摘　　要：目的探讨实时心肌超声造影定量评估冠脉慢血流（CSF）患者心肌血流灌注的应用价值。方法选取14例CSF患者（CSF组）及15例冠状动脉造影检查正常者（对照组），对两组人选对象分别进行实时心肌超声造影及常规二维超声心动图检查，于常规心尖四腔观、心尖左室长轴观及心尖两腔观采集图像并存储，利用QLab软件定量分析CSF组与对照组左室相应节段的心肌血流灌注并进行统计学分析。结果CSF组异常节段的心肌血流速率（β）、心肌血流量（MBF）较正常节段显著减低，差异具有统计学意义（P〈0．001），造影剂峰值密度（A）虽也较正常节段减低，但差异无统计学意义（P〉0．05）；CSF组异常节段的β值、MBF值较对照组减低（P〈0．001）；两组间正常节段A值、β值、MBF值差异均无统计学意义（P〉0．05）；应用ROC曲线计算A值、β值、MBF值预测CSF的心肌血流灌注受损程度，口值的曲线下面积最大（AUC=0．867，P〈0．001），当截断值取β=1．34时，敏感性和特异性分别可达79．6％、77．4％。结论实时心肌超声造影可定量评估CSF患者心肌血流灌注，口值可反映早期CSF患者心肌微循环受损程度，为CSF的确诊提供诊断依据。Objective To discuss the clinical value of real-time myocardial contrast echocardiography （RT-MCE） on quantitative assessing myocardial perfusion in patients with coronary slow flow（CSF）. Methods CSF group contained 14 patients with CSF and 15 cases with normal coronary angiography （CAG） were involved as control group. The 2D eehocardiography and RT-MCE images from standard 3 apical views （4-chamber, 2-chamber, and long-axis） were acquired. All images were digitally stored on hard disks for offline analysis by QLab software. The RT-MCE parameters included myocardial blood volume （A）, myocardial blood veloity（β）, myocardial Mood flow（MBF） were used to predict the impairment of myocardial perfusion in the two groups. Results In CSF group, the value of β and MBF in abnormal segments were significantly lower than those in normal segments （ P 〈0. 001）. There was no significant difference of A between the abnormal segments and the normal segments in CSF group （P 〈0.05）. Compared to the control group, the value of β and MBF were significantly lower in abnormal segments of CSF group（ P 〈0. 001 ）. Comparing the normal segments of two groups, there was no significant difference in the values of A, β and MBF （ P 〈0.05）. ROC curve analysis showed the AUC of β was the biggest （AUC = 0.867, P 〈 0.001 ）, and when the cut-off value was 1.34, the impairment of myocardial microcirculation was best predicted （sensitivity, 79.6% ; specificity, 77.4% ）. Conclusions The myocardial perfusion in patients with CSF can be appraised by RT-MCE quantitatively. The value ofβ can identify the early impairment of myocardial microcirculation perfusion in patients with CSF and has the promisingprospect of clinical diagnosis.

关 键 词：超声心动描记术 冠状动脉疾病 心肌微循环 心肌灌注 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.3[医药卫生—诊断学]