心肌声学造影评估存活心肌的临床价值
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摘要
冠心病患者具有一定程度的心肌缺血,临床上大多会选择行经皮冠状动脉介入术(PCI)疏通大血管,从而达到改善心肌缺血、缓解临床症状的效果。然而大量临床经验表明,一些行PCI的冠心病患者,术后症状及心功能并未明显改善。因此若能在术前有效评价存活心肌,使得行PCI的适应证更加精确、具体化,患者将得到更大的受益。随着影像技术的飞速发展,目前检测存活心肌的方法也越来越多,尤其正电子发射断层显像被认为是检测存活心肌的金标准,但因其各自的局限性均未广泛应用于临床。而心肌声学造影是一项新型超声技术,因无创、好操作等优势近些年逐渐得到发展,可通过检测心肌微循环灌注情况,进而判断存活心肌。
Patients with coronary heart disease have a certain degree of myocardial ischemia,and most of them will choose percutaneous coronary intervention( PCI) to clear the large blood vessels,so as to improve myocardial ischemia and relieve clinical symptoms. However,a lot of clinical experience has shown that some patients with coronary heart disease undergoing PCI have no significant improvement in postoperative symptoms and cardiac function. Therefore,if the viable myocardium can be effectively evaluated before surgery to make the indications for PCI are more accurate and specific,the patients will get more benefits. With the rapid development of imaging technology,there are more and more methods for detecting viable myocardium,especially that positron emission tomography is considered as the gold standard for detecting viable myocardium,but it is not widely used in clinic because of its limitations. Myocardial contrast echocardiography is a new type of ultrasound technology,which has been gradually developed in recent years due to its non-invasiveness and good operation. It can detect viable myocardium by detecting myocardial microcirculation perfusion.
Patients with coronary heart disease have a certain degree of myocardial ischemia,and most of them will choose percutaneous coronary intervention( PCI) to clear the large blood vessels,so as to improve myocardial ischemia and relieve clinical symptoms. However,a lot of clinical experience has shown that some patients with coronary heart disease undergoing PCI have no significant improvement in postoperative symptoms and cardiac function. Therefore,if the viable myocardium can be effectively evaluated before surgery to make the indications for PCI are more accurate and specific,the patients will get more benefits. With the rapid development of imaging technology,there are more and more methods for detecting viable myocardium,especially that positron emission tomography is considered as the gold standard for detecting viable myocardium,but it is not widely used in clinic because of its limitations. Myocardial contrast echocardiography is a new type of ultrasound technology,which has been gradually developed in recent years due to its non-invasiveness and good operation. It can detect viable myocardium by detecting myocardial microcirculation perfusion.
引文
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[22]蒲冬玉,邢艳秋.心肌声学造影的发展及研究现状[J].医学综述,2014,12(24):4531-4533.
[23]王宇航,杜国庆.超声心动图评价心肌梗死面积的研究进展[J].医学影像学杂志,2017,27(4):759-761.
[24]Li DY,Liang L,Xu TD,et al.The value of quantitative real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease[J].Clin Cardiol,2013,36(8):468-474.
[25]Li X,He S,Zhang YS,et al.Resting myocardial contrast echocardiography for the evaluation of coronary microcirculation dysfunction in patients with early coronary artery disease[J].Clin Cardiol,2016,39(8):453-458.
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[29]徐海涛.实时心肌声学造影结合多巴酚丁胺负荷对冠心病介入治疗前后心肌灌注的评价[J].中外医学研究,2015,13(15):39-41.
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[32]Amsavelu S,Christakopoulos GE,Karatasakis A,et al.Impact of crossing strategy on intermediate-term outcomes after chronic total occlusion percutaneous coronary intervention[J].Can J Cardiol,2016,32(10):1239.e1-1239.e7.
[33]Habara M,Tsuchikane E,Muramatsu T,et al.Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry[J].Catheter Cardiovasc Interv,2016,87(6):1027-1035.
[34]徐磊,刘畅,修春红,等.实时心肌超声造影检测冠状动脉慢性完全闭塞患者存活心肌[J].中华胸心血管外科杂志,2013,29(10):600-603.
[35]高蕊,齐向前.冠心病存活心肌识别方法[J].医学综述,2017,23(23):4699-4703.
[36]Schinkel AF,Valkema R,Geleijnse ML,et al.Single-photon emission computed tomography for assessment of myocardial viability[J].EuroIntervention,2010,6 Suppl G:G115-122.
[37]Hickman M,Janardhanan R,Dwivedi G,et al.Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability:A comparative study with myocardial contrast echocardiography and single photon emission computed tomography[J].Int J Cardiol,2007,114(1):139-140.
[38]Tousek P,Penicka M,Tintera J,et al.Identification of hibernating myocardium with myocardial contrast echocardiography:Comparison with late gadolinium-enhanced magnetic resonance[J].Int JCardiol,2008,128(1):117-120.
[39]黄晓东.小剂量多巴酚丁胺负荷超声心动图关于心肌梗死患者心肌存活性检测的研究[J].中外医疗,2013,32(18):184.
[40]Hickman M,Chelliah R,Burden L,et al.Resting myocardial blood flow,coronary flow reserve,and contractile reserve in hibernating myocardium:Implications for using resting myocardial contrast echocardiography vs.dobutamine echocardiography for the detection of hibernating myocardium[J].Eur J Echocardiogr,2010,11(9):756-762.
[41]Korosoglou G,Hansen A,Hoffend J,et al.Comparison of real-time myocardial contrast echocardiography for the assessment of myocardial viability with fluorodeoxyglucose-18 positron emission tomography and dobutamine stress echocardiography[J].Am JCardiol,2004,94(5):570-576.
[2]Ahern RM,Lozano R,Naghavi M,et al.Improving the public health utility of global cardiovascular mortality data:The rise of ischemic heart disease[J].Popul Health Metr,2011,9(1):8.
[3]Mendes A.Coronary heart disease:Self-care,communication and quality of life[J].Br J Community Nurs,2015,20(1):42.
[4]Bruschke AV,Sheldon WC,Shirey EK,et al.A half century of selective coronary arteriography[J].J Am Coll Cardiol,2009,54(23):2139-2144.
[5]Ito H,Tomooka T,Sakai N,et al.Lack of myocardialperfusion immediately after successful thrombolysis.A predictor of poor recovery of left ventricular function in anterior myocardial infarction[J].Circulation,1992,85(5):1699-1705.
[6]Kaul S,Ito H.Microvasculature in acute myocardial ischemia:PartⅡ:Evolving concepts in pathophysiology,diagnosis,and treatment[J].Circulation,2004,109(3):310-315.
[7]Jespersen L,Hvelplund A,Abildstrm SZ,et al.Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events[J].Eur Heart J,2012,33(6):734-744.
[8]徐磊,刘宏宇.心肌超声造影评价存活心肌的应用进展[J].中国胸心血管外科临床杂志,2012,19(5):551-554.
[9]杨波,邓云超,谭利国,等.冠状动脉慢性完全闭塞病变治疗研究进展[J].中国心血管病研究,2016,14(11):965-969.
[10]王龙彪,王惜诵,李伟.PET/MRI融合显像对存活心肌评价的研究进展[J].解放军医药杂志,2011,23(6):50-52.
[11]丁尚伟.实时心肌超声造影结合多巴酚丁胺负荷试验对急性心肌梗死犬存活心肌的定量研究[D].武汉:华中科技大学,2008.
[12]刘文慈,崔冰.评估心肌存活性的影像学研究进展[J].广东医学,2011,32(21):2874-2876.
[13]Patel P,Ivanov A,Ramasubbu K.Myocardial Viability and Revascularization:Current Understanding and Future Directions[J].Curr Atheroscler Rep,2016,18(6):1-7.
[14]Bax JJ,Delgado V.Detection of viable myocardium and scar tissue[J].Eur Heart J Cardiovasc Imaging,2015,16(10):1062-1064.
[15]孙茉茉,李剑明,刘志刚.PET/CT检测冠状动脉旁路移植术患者存活心肌的研究进展[J].医学综述,2017,23(16):3291-3295.
[16]张晓晖.微循环阻力指数评估冠脉微循环障碍及其与冠心病危险因素聚集的相关性研究[D].南京:东南大学,2015.
[17]Fearon WF,Low AF,Yong AS,et al.Prognostic value of the Index of Microcirculatory Resistance measured after primary percutaneous coronary intervention[J].Circulation,2013,127(24):2436-2441.
[18]Martínez GJ,Yong AS,Fearon WF,et al.The index of microcirculatory resistance in the physiologic assessment of the coronary microcirculation[J].Coron Artery Dis,2015,26 Suppl 1:e15-26.
[19]玄昌波,王显.冠状动脉微循环障碍研究进展[J].中国循证心血管医学杂志,2016,8(10):1275-1278.
[20]杨四花,端木伟文.超声心动图评价存活心肌的研究进展[J].医学综述,2012,18(19):3262-3264.
[21]王煜伦,孙根义.心肌造影及负荷超声心动图评价存活心肌的研究进展[J].天津医科大学学报,2008,14(4):585-588.
[22]蒲冬玉,邢艳秋.心肌声学造影的发展及研究现状[J].医学综述,2014,12(24):4531-4533.
[23]王宇航,杜国庆.超声心动图评价心肌梗死面积的研究进展[J].医学影像学杂志,2017,27(4):759-761.
[24]Li DY,Liang L,Xu TD,et al.The value of quantitative real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease[J].Clin Cardiol,2013,36(8):468-474.
[25]Li X,He S,Zhang YS,et al.Resting myocardial contrast echocardiography for the evaluation of coronary microcirculation dysfunction in patients with early coronary artery disease[J].Clin Cardiol,2016,39(8):453-458.
[26]刘娅妮,邓又斌.心肌造影超声心动图与存活心肌的检测[J].中国医学影像技术,2004,20(1):153-155.
[27]Yu J,Han J,Mao J,et al.Association between serum uric acid level and the severity of coronary artery disease in patients with obstructive coronary artery disease[J].Chin Med J(Engl),2014,127(6):1039-1045.
[28]Galiuto L,Locorotondo G,Paraggio L,et al.Characterization of microvascular and myocardial damage within perfusion defect area at myocardial contrast echocardiography in the subacute phase of myocardial infarction[J].Eur Heart J Cardiovasc Imaging,2012,13(2):174-180.
[29]徐海涛.实时心肌声学造影结合多巴酚丁胺负荷对冠心病介入治疗前后心肌灌注的评价[J].中外医学研究,2015,13(15):39-41.
[30]King SB 3rd,Av Prsann T,Ballard WL,et al.ACCF/AHA/SCAI2007 update of the clinical competence statement on cardiac interventional procedures:A reort of the Amrican College of Cardiology Foundation/Amrican Heart Association College of Physicians Task Force on Clinical Competence and Training(writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures)[J].J Am Coll Cardiol,2007,50(1):82-108.
[31]Sapontis J,Christopoulos G,Grantham JA,et al.Procedural failure of chronic total occlusion percutaneous coronary intervention:Insights from a multicenter US registry[J].Catheter Cardiovasc Interv,2015,85(7):1115-1122.
[32]Amsavelu S,Christakopoulos GE,Karatasakis A,et al.Impact of crossing strategy on intermediate-term outcomes after chronic total occlusion percutaneous coronary intervention[J].Can J Cardiol,2016,32(10):1239.e1-1239.e7.
[33]Habara M,Tsuchikane E,Muramatsu T,et al.Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry[J].Catheter Cardiovasc Interv,2016,87(6):1027-1035.
[34]徐磊,刘畅,修春红,等.实时心肌超声造影检测冠状动脉慢性完全闭塞患者存活心肌[J].中华胸心血管外科杂志,2013,29(10):600-603.
[35]高蕊,齐向前.冠心病存活心肌识别方法[J].医学综述,2017,23(23):4699-4703.
[36]Schinkel AF,Valkema R,Geleijnse ML,et al.Single-photon emission computed tomography for assessment of myocardial viability[J].EuroIntervention,2010,6 Suppl G:G115-122.
[37]Hickman M,Janardhanan R,Dwivedi G,et al.Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability:A comparative study with myocardial contrast echocardiography and single photon emission computed tomography[J].Int J Cardiol,2007,114(1):139-140.
[38]Tousek P,Penicka M,Tintera J,et al.Identification of hibernating myocardium with myocardial contrast echocardiography:Comparison with late gadolinium-enhanced magnetic resonance[J].Int JCardiol,2008,128(1):117-120.
[39]黄晓东.小剂量多巴酚丁胺负荷超声心动图关于心肌梗死患者心肌存活性检测的研究[J].中外医疗,2013,32(18):184.
[40]Hickman M,Chelliah R,Burden L,et al.Resting myocardial blood flow,coronary flow reserve,and contractile reserve in hibernating myocardium:Implications for using resting myocardial contrast echocardiography vs.dobutamine echocardiography for the detection of hibernating myocardium[J].Eur J Echocardiogr,2010,11(9):756-762.
[41]Korosoglou G,Hansen A,Hoffend J,et al.Comparison of real-time myocardial contrast echocardiography for the assessment of myocardial viability with fluorodeoxyglucose-18 positron emission tomography and dobutamine stress echocardiography[J].Am JCardiol,2004,94(5):570-576.