超声造影定量分析可评估冠状动脉的狭窄程度  

Quantitative myocardial contrast echocardiography can evaluate degree of coronary artery stenosis

作　　者：牛义翠 田刚[1] 郑敏娟 马慧 刘璐 NIU Yicui;TIAN Gang;ZHENG Minjuan;MA Hui;LIU Lu(Department of Internal Medicine-Cardiovascular,The First Affiliated Hospital of Xi'an Jiao Tong University Medical College,Xi'an 710061,China;Department of Ultrasound Medicine,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]西安交通大学医学院第一附属医院心血管内科,陕西西安710061 [2]空军军医大学西京医院超声医学科,陕西西安710032

出　　处：《分子影像学杂志》2023年第5期836-840,共5页Journal of Molecular Imaging

基　　金：陕西省国际科技合作计划重点项目(2022KWZ-19);西安市科技计划项目(21YXYJ0105)。

摘　　要：目的探讨超声造影定量分析与冠状动脉狭窄程度的相关性,评价其对冠心病狭窄程度的预测价值。方法连续性纳入我院门诊怀疑冠心病的患者35例,接受心肌声学造影检查后行冠状动脉造影和/或冠状动脉CT血管成像,按冠状动脉造影和/或冠状动脉CT血管成像结果将其分为冠心病组(冠脉狭窄≥75%,n=20)和对照组(冠脉狭窄<75%,n=15),比较两组的临床指标和二维超声;另按冠脉支数测量超声造影定量参数,绘制ROC曲线评价造影参数预测冠状动脉狭窄≥75%的敏感度和特异性。结果与对照组相比,冠心组高血压、吸烟史比率更高(50.00%vs 13.33%、65.00%vs 26.67%,P<0.05),二维超声提示节段性室壁运动异常发生率高(90.00%vs 46.67%,P<0.05)。超声造影结果示,两组间心肌峰值强度、曲线下面积的差异均有统计学意义(P<0.001)。ROC曲线分析显示,心肌峰值强度、曲线下面积预测冠脉狭窄程度≥75%的预警值为5.91 dB(敏感度、特异性分别为97.8%、95.2%)和28.94 dB sec(敏感度、特异性分别为66.7%、74.8%)。结论超声造影定量分析无创、简便,适合长期随访,可较为准确地评估心肌缺血,有助于临床判断冠脉狭窄程度和指导后续治疗。Objective To explore the correlation between quantitative myocardial contrast echocardiography(MCE)and the degree of coronary artery stenosis,and evaluate its predictive value on the the degree of coronary artery stenosis.Methods A total of 35 patients with suspected coronary heart disease were continuously enrolled in our hospital.All patients underwent MCE,coronary angiography and/or coronary CT angiography.According to coronary angiography and/or coronary CT angiography results,the patients were divided into two groups:coronary artery disease group(coronary artery stenosis≥75%,n=20)and control group(coronary artery stenosis<75%,n=15).Clinical indicators and two-dimensional ultrasound were compared between two groups.In addition,quantitative parameters of MCE were measured according to the number of coronary arteries,and ROC curve evaluate the sensitivity and specificity of MCE parameters in predicting coronary artery stenosis≥75%.Results The proportion of hypertension and smoking history were higher in the coronary group than that in the control group(50.00%vs 13.33%,65.00%vs 26.67%,P<0.05),and two-dimensional ultrasound showed a high incidence of segmental wall motion abnormalities(90.00%vs 46.67%,P<0.05).Contrast-enhanced ultrasound showed that there were significant differences in peak myocardial intensity and area under the curve between the two groups(P<0.001).ROC curve analysis showed that peak myocardial intensity and area under the curve had a predictive value of 5.91 dB(sensitivity and specificity were 97.8%and 95.2%)and 28.94 dB sec(sensitivity and specificity were 66.7%and 74.8%)in predicting the degree of coronary artery stenosis≥75%.Conclusion Contrast-enhanced ultrasound quantitative analysis is non-invasive,simple and suitable for long-term follow-up.It can accurately evaluate myocardial ischemia and is helpful for clinical judgement coronary artery stenosis degree and guidance for subsequent treatment.

关 键 词：冠心病 心肌声学造影 冠脉造影 冠状动脉CT血管成像 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]