应用组织追踪法结合小剂量多巴酚丁胺负荷试验评价心肌存活性  

Assessing Myocardial Viability in Patients with Myocardial Infarction Using Tissue Tracking Combined with Low-dose Dobutamine Stress

作　　者：毕小军[1] 邓又斌[1] 常青[1] 白娇[1] 刘红云[1] 杨好意[1] 黎春雷[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院超声影像科,武汉市430030

出　　处：《中国超声医学杂志》2004年第5期347-351,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的　探讨应用组织追踪法 (TT)测定二尖瓣瓣环收缩期位移结合小剂量多巴酚丁胺负荷超声心动图试验 (L DDSE)评价心肌存活性的价值。方法　 2 0例心肌梗死患者均行经皮腔内冠状动脉成形术 (PTCA)或 PTCA+支架术。术前 1周内进行 L DDSE,术后 (>6周 )复查超声心动图。在 L DDSE前后及 PTCA术后 ,分别在心尖四腔心切面、两腔心切面及心尖左心长轴切面记录后室间隔、侧壁、下壁、前壁、后壁及前室间隔处二尖瓣瓣环的位移曲线 ,测量各瓣环处收缩期最大位移 ,然后求出其平均值 ;计算各二尖瓣瓣环取样点处收缩期位移在 L DDSE前后的差值 (Δ D)及百分变化率。根据患者术后随访情况将其分为室壁运动有改善组和无改善组 ;10例冠脉造影结果为阴性的受检者作对照组。结果　 L DDSE结束时 ,各组心肌梗死患者用 TT法测得的有节段性运动异常室壁所对应的二尖瓣瓣环收缩期位移较静息状态时均有不同程度升高 ;但在室壁运动有改善组中 ,其二尖瓣瓣环收缩期位移的升高值 [(2 .2± 0 .8) mm vs(0 .5± 0 .5 ) mm,P<0 .0 1]和百分变化率 (38%± 12 % vs 8%± 7% ,P<0 .0 1)均明显高于室壁运动无改善组。 PTCA术后 ,用 TT法测得的有节段性运动异常室壁所对应的二尖瓣瓣环收缩期位移在术后有改善组 ,较术前静息状态明显升高 [Objective To assess myocardial viability in patients with myocardial infarction by observing the change of the systolic mitral annular displacement(MAD) with tissue tracking(TT) combined with low-dose dobutamine stress echocardiography(LDDSE).Methods Twenty patients with myocardial infarction underwent percutaneous trasluminal coronary angioplasty(PTCA) or PTCA plus stent.LDDSE were performed before operation.The MAD of 6 sites from the apical four chamber,long axis and two chamber views were measured with TT before and after LDDSE and after operation.The change(ΔD) and the percent change in MAD induced by LDDSE were measured.Results The MAD of the sites corresponding to the infarcted myocardium raised at different level at the end of LDDSE in all the patients.But the ΔD(2.2±0.8 mm vs 0.5±0.5 mm,P<0.01) and percent change(38±12% vs 8±7%,P<0.01) of MAD were significant higher in the group with viable myocardium than those in the group without viable myocardium.The MAD of the sites corresponding to the infarcted myocardium was significantly raised after PTCA in the group with viable myocardium(7.9±2.5 vs 5.8±2.6 mm,P<0.01).But in the group without viable myocardium,PTCA did not significantly increase the MAD of the sites corresponding to the infarcted myocardium(5.9±2.6 vs 5.7±2.4 mm,P>0.05).The sensitivity and specificity of ΔD>18 mm for detecting survived myocardium were 81% and 82%,respectively.Conclusions Observing the change of MAD with TT combined with LDDSE can assess myocardial viability.

关 键 词：组织追踪法 小剂量 多巴酚丁胺 负荷试验 心肌存活性 心肌梗死 TT 

分 类 号：R542.22[医药卫生—心血管疾病]