实时三维斑点追踪成像结合实时心肌声学造影预测心肌梗死后患者心肌存活性的临床研究  

The prediction of left ventricular myocardial viability in patients after myocardial infarction by real time three-dimensional speckle tracking imaging combined with real time myocardial contrast echocardiography:a clinical study

作　　者：李云[1] 李华[1] 胡劼[1] LI Yun;LI Hua;HU Jie.(Department of Echocardiography, Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi 830000, Chin)

机构地区：[1]新疆医科大学附属中医医院心脏超声科

出　　处：《中国心血管病研究》2018年第4期314-318,I0001,共6页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区自然科学基金资助项目(项目编号:2015211C147)

摘　　要：目的探讨实时三维斑点追踪成像技术（RT-3D—STI）结合实时心肌声学造影（RT—MCE）技术评价心肌梗死后患者心肌存活性的临床应用价值。方法选取25例根据心电图、心肌酶学及冠脉造影确诊，且成功进行冠状动脉血运重建术的心肌梗死患者。所有患者于术前1周内行RT—MCE检查，对心肌灌注结果进行半定量评价；分别于术前及术后6个月行二维超声分析左室各节段心肌进行室壁运动，根据术后室壁运动是否改善将室壁运动异常的心肌节段分为2组：存活心肌组和非存活心肌组；同时行RT-3D—STI技术测得左室心肌整体及各节段三维峰值长轴应变（3D—LPS）、环向应变（3D—CPS）、面积应变（3D—APS）及径向应变（5D—RPS）参数指标。结果血运重建术前，存活心肌组3D—PLS、3D—PAS、5D—PCS、39-PRS明显高于无存活心肌组（P〈0．05）。单参数ROC曲线分析结果显示，静息状态下，以术前3D—PAS≤-16．5％作为截断值判断心肌梗死后存活心肌的AUC为0．944，敏感度为91．3％，特异度为93．8％，明显高于其他应变值。多参数联合分析结果显示，三维应变参数联合判断心肌梗死后存活心肌的AUC为0．969，灵敏度及特异度分别为95．7％、90．6％。血运重建术前，RT—MCE评价存活心肌的敏感度及特异度分别为93．1％、68．8％，一致性分析得出Kappa值为0．645。结论在静息状态下，RT-3D—STI技术预测心肌梗死后心肌存活的价值高于RT—MCE技术，其中三维应变参数以3D—PAS≤-16．5％作为截断值判断心肌梗死后心肌存活性的价值最高，且两种技术联合应用能更好地评价心肌存活性。Objective The aim of the present study was to investigate the value of predicting on the left ventricular myocardial viability in patients after myocardial infarction by real time three-dimensional speckle track- ing imaging（RT-3D-STI ） combined with real time myocardial contrast echocardiography（ RT-MCE ）. Methods 25 patients diagnosed with myocardial infarction by ECG, myocardial enzymes and coronary angiography and success- fully provided with coronary revascularization were recruited. Before revascularization, semi-quantitative evaluation of myocardial perfusion were determined by RT- MCE. After 6 months of follow-up, the patients were grouped into viable myocardium group and non-viable myocardium group based on whether having myocardial segmental wall mo- tion improvement or not after revascularization. Before and after revascularization, longitudinal peak strain （3D- GLPS）, circumferential peak strain（3D-GCPS）, radial peak strain（3D-GRPS） and area peak strain （3D-GAPS） by RT-3D-STI were measured for functional analysis. Results Before revascularization, 3D-PLS, 3D-PAS, 3D- PCS, 3D-PRS in myocardial viability group were significantly higher than those of non-viable myocardium group （P〈0.05）; the single parameter mode of ROC curve analysis showed that at resting state, the cutoff value of 3D- PAS which can assess myocardial viability was less than -16.5%, with a significantly higher A UC （0.944）, sensi- tivity （91.3%）, specificity （93.8%） than the other strains; the single technology mode of ROC curve analysis showed that 4D-SI had a AUC（0.969）, sensitivity（95.7%） and specificity（90.6%）. Before revascularization, the sensitivity and specificity of RT-MCE in assessing myocardial viability were 93.1% and 68.8%, the Kappa value was 0.645. Conclusion At resting state, RT-3D-STI has a higher value to predict myocardial viability after my- ocardial infarction than RT-MCE, among the three-dimensional strain parameters the cutoff value of 3D-PAS which can assess m

关 键 词：三维斑点追踪 应变 心肌声学造影 心肌梗死 血运重建术 心肌存活性 

分 类 号：R542.22[医药卫生—心血管疾病]