心肌血流灌注与室壁运动在评价冠状动脉疾病中的应用  

Application of myocardial perfusion and wall motion in assessing coronary artery disease

作　　者：张少文[1] 吴胜楠[2] 林钟文[2] 董少红[2] 梁旭[2] 吴瑛[1] 

机构地区：[1]暨南大学医学院第二附属医院深圳市人民医院超声科,深圳518020 [2]暨南大学医学院第二附属医院深圳市人民医院心内科,深圳518020

出　　处：《中华超声影像学杂志》2003年第12期716-719,共4页Chinese Journal of Ultrasonography

基　　金：深圳市医药卫生科技计划基金资助(1 9980 6 0 0 1)

摘　　要：目的　评价心肌血流灌注与室壁运动 (WM )对预测冠状动脉疾病 (CAD)的应用价值。方法　用间歇二次谐波脉冲反转显像技术 ,对 48例经冠状动脉造影证实的CAD患者行静脉心肌声学造影(MCE)。采用 16节段划分法 ,进行目测半定量心肌造影计分 (MCS) :回声均匀性增强 ,显影时间≤ 90s为1分 ;回声低淡不均匀 ,显影延时 (>90s)为 0 .5分 ;充盈缺损为 0分。室壁运动计分 (WMS) :运动正常、减弱、无运动及矛盾运动分别为 1、2、3、4分。结果　MCE、WM和两者联合应用预测CAD均具有高度的敏感性、特异性和准确性。MCE的敏感性和准确性均高于WM (均 P <0 .0 5)。联合应用MCE和WM的敏感性显著高于WM(P <0 .0 0 1) ,准确性也高于WM (P <0 .0 5) ,与MCE相比敏感性和准确性差异无显著性意义 (均P >0 .0 5)。 3种方法具有类似的特异性 (均P >0 .0 5)。MCS与WMS的等级相关r =-0 .58,P <0 .0 0 1。两者的符合率为 78%。结论　MCE、WM和两者联合应用预测CAD均具有高度的敏感性、特异性和准确性。MCE和MCE +WM预测CAD比WM更敏感和准确。局部心肌血流灌注与室壁运动有较好的符合率 ,且两者的异常程度也有一定的相关性 ,因此MCEObjective To estimate prospectively applica tion of myocardial perfusion and wall motion(WM) in coronary artery disease(CAD). Methods Fourty-eight patients with CAD underwent both myocardial contrast echocardiography (MCE) with intermittent harmonic pulsed inversion imaging following intravenous injection of Levovist and coronary angiography(CAG) within three days. Estimations of myocardial contrast score(MCS) and WM score(WMS) were made by visual analysis in 16-segments model of left ventricular walls. MCS was graded as 1, homogeneous opacification normal and myocardial contrast opacified time(MCOT) ≤90 s; 0.5 , patchy pattern and prolonged MCOT >90 s; 0, no opacification. WMS was graded as 1, normal; 2, hypokinesis; 3, akinesis; 4, dyskinesis. Results The sensitivity, specificity and accuracy in predicting ≥50% CAD stenosis were 87.1 %, 89.8 % and 88.2 % in MCE; 75.3 %, 84.7 % and 79.2 % in WM; 91.8 %, 81.4 % and 87.5 % in MCE+WM respectively. The sensitivity and accuracy of MCE were higher than those of WM (P< 0.05 ), MCE+WM had significant higher sensitivity (P< 0.001 ) and accuracy (P< 0.05 ) than WM. MCE+WM could not improve the sensitivity, specificity and accuracy of MCE. MCS correlated with WMS well (r= -0.58 ,P< 0.001 ) and the concordance between MEC and WM was 78%. The normal or abnormal perfusion-motion matched segment identified 81.4 % (48/59) and 70.6 % (60/85) of normal and stenosis coronary artery respectively, while the perfusion-motion unmatched segment(either abnormal perfusion with normal WM segment or normal perfusion with abnormal WM segment) identified only 21.2 %(18/85) of stenosis coronary artery (P< 0.001 ). Conclusions MCE,WM and MCE+WM all had a high sensitivity,specificity and accuracy in predicting CAD. But MCE and MCE+WM had a higher sensitivity and accuracy than WM in the prediction. Regional myocardial perfusion correlated well with concomitant WM. Therefore, the perfusion-motion matched segment (both are normal or abno

关 键 词：心肌血流灌注 室壁运动 冠状动脉疾病 超声心动描记术 冠心病 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.1[医药卫生—诊断学]