超声斑点追踪联合小剂量多巴酚丁胺负荷超声心动图与心脏磁共振检查对非ST段抬高型心肌梗死患者存活心肌的预测价值研究  

Predictive Value of Speckle Tracking Echocardiography Combined with Low-dose Dobutamine Stress Echocardiography and Cardiac Magnetic Resonance on Viable Myocardium in Patients with Non-ST-segment Elevation Myocardial Infarction

作　　者：李高同 李东野 LI Gaotong;LI Dongye(Institute of Cardiovascular Disease,Xuzhou Medical University,Xuzhou 221009,China;Color Doppler Ultrasound Room,Xuzhou Hospital of Traditional Chinese Medicine,Xuzhou 221003,China)

机构地区：[1]徐州医科大学心血管病研究所,江苏省徐州市221009 [2]江苏省徐州市中医院彩超室,221003

出　　处：《实用心脑肺血管病杂志》2020年第10期43-47,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景存活心肌是判断急性心肌梗死患者冠状动脉再通后心脏功能的有效指标之一,但目前非ST段抬高型心肌梗死(NSTEMI)患者存活心肌的判断标准尚不统一,且关于超声及影像学检查对NSTEMI患者存活心肌预测价值的研究报道较少见。目的探讨超声斑点追踪(STE)联合小剂量多巴酚丁胺负荷超声心动图(LDDSE)与心脏磁共振(CMR)检查对NSTEMI患者存活心肌的预测价值。方法本研究为前瞻性研究,共纳入2017年1月—2018年1月在徐州市中医院和徐州医科大学附属医院行择期经皮冠状动脉介入治疗(PCI)的NSTEMI患者59例。所有患者于PCI前及PCI后1、3、6个月进行超声心动图检查,并于PCI前1周完成STE联合LDDSE、CMR检查。以PCI后复查超声心动图发现左心室室壁运动评分较PCI前降低>1分为判断存活心肌的金标准,分析STE联合LDDSE、CMR检查对NSTEMI患者存活心肌的预测价值。结果PCI后复查超声心动图发现左心室室壁运动异常变化节段432个,其中存活心肌298个,非存活心肌134个。存活心肌静息及负荷状态径向应变(RS)、径向应变率(RSr)低于非存活心肌(P<0.05);存活心肌、非存活心肌静息状态RS、RSr高于负荷状态(P<0.05)。在超声心动图复查发现的432个左心室室壁运动异常变化节段中,CMR检查判断为存活心肌者273个,非存活心肌者159个;CMR检查预测NSTEMI患者存活心肌的灵敏度为85.9%,特异度为87.3%。ROC曲线分析结果显示,静息状态RS、负荷状态RS、静息状态RSr、负荷状态RSr、STE联合LDDSE检查、CMR检查预测NSTEMI患者存活心肌的曲线下面积分别为0.531〔95%CI(0.429,0.669)〕、0.876〔95%CI(0.800,0.950)〕、0.729〔95%CI(0.625,0.832)〕、0.823〔95%CI(0.749,0.912)〕、0.885〔95%CI(0.812,0.957)〕、0.902〔95%CI(0.840,0.969)〕。结论STE联合LDDSE检查、CMR检查对NSTEMI患者存活心肌的预测价值均较高,具有一定推广应用价值。Objective Viable myocardium is one of effective indicators for judging heart function after coronary artery recanalization in acute myocardial infarction,however the judgement standard for viable myocardium is not unified in non-STsegment elevation myocardial infarction(NSTEMI)so far,and there is few reports about predictive value of ultrasound and imaging examinations in predicting viable myocardium in NSTEMI.Objective To investigate the predictive value of speckle tracking echocardiography(STE)combined with low-dose dobutamine stress echocardiography(LDDSE)and cardiac magnetic resonance(CMR)on viable myocardium in patients with NSTEMI.Methods As a prospective study,we enrolled 59 NSTEMI patients prepared for elective percutaneous coronary intervention(PCI)in Xuzhou Hospital of Traditional Chinese Medicine and the Affiliated Hospital of Xuzhou Medical University from January 2017 to January 2018.All of the 59 patients underwent echocardiography before PCI,1 month,3 months and 6 months after PCI,underwent STE combined with LDDSE and CMR 1 week before PCI.Taking left ventricular wall motion score reducing over 1 as golden standard of viable myocardium by reexamination of echocardiography after PCI,the predictive value of STE combined with LDDSE and CMR was analyzed,respectively.Results There were 432 segments with abnormal movement of left ventricular wall confirmed by reexamination of echocardiography after PCI,including 298 viable myocardium and 134 non-viable myocardium.Both radial strain(RS)and radial strain rate(RSr)in viable myocardium were statistically significantly lower than those in non-viable myocardium at resting state and stressing state(P<0.05),meanwhile RS and RSr at resting state were statistically significantly higher than those at stressing state both in viable myocardium and non-viable myocardium(P<0.05).Of the 432 segments with abnormal movement of left ventricular wall confirmed by reexamination of echocardiography after PCI,273 were viable myocardium and 159 were non-viable judged by CMR,wit

关 键 词：心肌梗死 心肌 超声心动描记术 压力 超声斑点追踪 多巴酚丁胺 磁共振成像 预测 

分 类 号：R542.22[医药卫生—心血管疾病]