实时心肌超声造影与心脏磁共振成像心肌灌注延迟显像评价急性心肌梗死微循环的对比分析  

Comparative analysis of real-time myocardial contrast echocardiography and delayed enhancement-mag⁃netic resonance imaging in evaluating microcirculation of acute myocardial infarction

作　　者：邱银汝 何祥发 王茹 蒋溢为 邱钦圣 丰一 张源祥 杜凡 贾国良 QIU Yin-ru;HE Xiang-fa;WANG Ru;JIANG Yi-wei;QIU Qin-sheng;FENG Yi;ZHANG Yuan xiang;DU Fan;JIA Guo-liang(Dongguan Kanghua Hospital,Dongguan,Guangdong 523080,China;Daojiao People′s Hospital,Dongguan,Guangdong 523000,China)

机构地区：[1]广东省东莞市东莞康华医院,广东东莞523080 [2]广东省东莞市道滘人民医院,广东东莞523000

出　　处：《岭南心血管病杂志》2021年第4期433-438,共6页South China Journal of Cardiovascular Diseases

基　　金：东莞市社会科技发展一般项目(项目编号:201850715059817)。

摘　　要：目的研究实时心肌超声造影(real-time myocardial contrast echocardiography,RT-MCE)与心脏磁共振成像心肌灌注延迟显像(delayed enhancement-magnetic resonance imaging,DE-MRI)在急性心肌梗死(acute myo⁃cardial infarction,AMI)微循环障碍的临床价值。方法选择2018年6月至2020年2月东莞康华医院收治的36例胸痛<24 h的AMI患者为对象,男29例,女7例,年龄(55±12)岁。其中“罪犯血管”前降支28例(78%),左旋支16例(44%),右冠状动脉18例(50%)。分别进行RT-MCE及DE-MRI检查,记录AMI患者两项影像学检查的心肌灌注(myocardial perfusion,MP)评分、室壁节段运动积分指数(wall motion score index,WMSI)和左心室射血分数(left ventricular ejection fraction,LVEF)的变化,以DE-MRI作为参考标准,对比分析RT-MCE评价心肌微循环障碍及心肌缺血、梗死范围的敏感度、特异度、准确度。结果RT-MCE检测MP和WMSI的敏感度分别是83.01%、86.03%,特异度是98.01%、94.43%,准确度是94.12%、94.44%。RT-MCE目测半定量法与DE-MRI法检测心肌微循环障碍均有较高的临床价值,两种影像学检测方法有较好的相关性。DE-MRI和RT-MCE检测MP和WMSI有明显差异,均具有统计学意义(P<0.05),二者相关系数为0.844和0.864,相关性良好。结论RT-MCE目测半定量法与DE-MRI法检测心肌微循环障碍有较高的临床价值,RT-MCE安全、操作简便,可用于急诊床旁检查,具有较高的临床应用价值。Objectives To study the clinical value of real-time myocardial contrast echocardiography(RT-MCE)and delayed enhancement-magnetic resonance imaging(DE-MRI)in acute myocardial infarction(AMI)microcirculation disorder.Methods From June 2018 to February 2020,36 AMI patients with chest pain<24 hours were selected as subjects,among them,29 cases were male patients and 7 cases were female patients,aged(55±12)years.In these patients,28 cases(78%)had culprit vessel in left anterior descending(coronary artery)(LAD),16 cases(44%)had culprit vessel in left circumflex(LCX),18 cases(50%)had culprit vessel in right coronary artery(RCA).RT-MCE and DE-MRI examinations were performed to record the changes of myocardial perfusion(MP),wall motion score index(WMSI)and left ventricular ejection fraction(LVEF)in patients with AMI.Using DE-MRI as a reference standard,the sensitivity,specificity and accuracy of RT-MCE for evaluating myocardial microcirculation disorders,myocardial ischemia and infarct range were analyzed.Results The sensitivities of RT-MCE to detect MP and WMSI were 83.01%,86.03%,specificities were 98.01%,94.43%,and accuracies were 94.12%,94.44%.RT-MCE visual semi quantitative method and DE-MRI method had high clinical value in detecting myocardial microcirculation disorders and the two imaging methods had a good correlation.DE-MRI and RT-MCE showed significant differences in MP and WMSI,both of which were statistically significant(P<0.05).The correlation coefficients between the two methods were 0.844 and 0.864,and the correlation was good(P<0.05).Conclusions RT-MCE visual semi-quantitative method and DE-MRI method have higher clinical value for detecting myocardial microcirculation disorders.RT-MCE is safe,easy to operate,and can be used for emergency bedside examination,which has high clinical application value.

关 键 词：心肌梗死 实时心肌超声造影 心脏磁共振成像 心肌灌注延迟显像 心肌微循环 

分 类 号：R542.22[医药卫生—心血管疾病]