心肌声学造影评估心肌微血管血流储备的临床研究  

Clinical study on microvascular reserve by myocardial contrast echocardiography using intravenously infused Levovist

作　　者：赵静[1] 张运[1] 张薇[1] 季晓平[1] 黎莉[1] 钟明[1] 李秀昌[1] 

机构地区：[1]山东大学齐鲁医院心内科,济南250012

出　　处：《中华超声影像学杂志》2004年第1期8-11,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目 (60 0 72 0 2 2 )

摘　　要：目的　探讨利声显经静脉心肌声学造影 (IMCE)评价心肌微血管血流储备的可行性和临床应用价值。方法　选择 10例冠状动脉造影正常 (I组 )和 8例左前降支 (LAD)存在 5 0 %～ 70 %狭窄的患者 (Ⅱ组 ) ,分别在静息状态和双嘧达莫负荷试验后进行两次IMCE检查。分析递增触发时的心肌多普勒信号并描绘时间 强度曲线 ,测量平台期心肌显影强度A、曲线上升平均斜率 β及A·β乘积在负荷试验前后的变化 ,并测定相应的储备值。结果　静息状态下两组均呈均匀一致的正常心肌灌注 ,负荷试验后两组的 β及A·β均较负荷前增加 ,差异有显著意义 (P <0 .0 5 ) ;负荷前后两组的A储备值差异无显著性意义 (P >0 .0 5 ) ,而Ⅰ组的 β储备值及A·β储备值均显著高于Ⅱ组 (分别为 3 .0 6± 0 .95vs 1.5 2± 0 .3 7,3 .3 0± 1.0 4vs 1.48± 0 .42 ,均P <0 .0 0 5 ) ,提示Ⅱ组的心肌微血管血流储备降低。结论　IMCE可用于检测轻中度狭窄冠状动脉支配区域的微血管血流储备异常。Objective To establish the feasibility and clinical applications of intravenous myocardial perfusion imaging with Levovist in assessing the coronary microcirculaton reserve.Methods Intravenous myocardial contrast echocardiography (IMCE) was performed pre and post dipyridamole injection in 10 cases with normal coronary angiography (group I) and 8 cases with 50% to 70% stenosis in the lift anterior descending branch(LAD) (group Ⅱ) respectively.A set of special instrumental setting and an integrated imaging approach including power Doppler imaging,incremental triggering imaging and harmonic imaging were utilized to record the apical four chamber view.The power Doppler signals of the septum were analyzed and the time amplitude curves were plotted during Levovist infusion and incremental triggering.The maximal amplitude score (A),the mean ascending slope of the curve(β) and the product of A·β were measured.The reserve of A,β and A·β were also calculated.Results At baseline,both group I and group Ⅱ had normal myocardial perfusion.After dipyridamole infusion,contrast score A increased slightly in group I and decreased in group Ⅱ without statistical significance.Both β and A·β were increased significantly after dipyradamole (P< 0.05 ).There was no difference in A reserve between the two groups,but β and A·β reserve was higher in group Ⅰ ( 3.06 ± 0.95 vs 1.52 ± 0.37 , 3.30 ± 1.04 vs 1.48 ± 0.42 ,P< 0.005 ),suggesting less microvascular reserve of blood flow in group Ⅱ.Conclusions IMCE using intravenously infused Levovist could identify the microcirculation reserve abnormalities in the regions supplied by the mild to moderate stenotic coronary artery.

关 键 词：心肌声学造影 心肌微血管血流储备 心肌缺血 心肌再灌注 冠状动脉造影 

分 类 号：R445.1[医药卫生—影像医学与核医学]