腺苷负荷下心肌声学造影显像评价冠心病心肌梗死患者存活心肌的研究
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摘要
目的评价心肌声学造影(MCE)结合腺苷负荷检测冠心病心肌梗死患者存活心肌的临床价值。方法选择临床确诊并拟接受冠脉血运重建的冠心病患者45例,常规心脏彩色多普勒超声显示左室壁共336个运动异常节段,血运重建前24h内行心肌声学造影检查,观测静息状态、静脉注射腺苷后室壁运动异常区域心肌微循环造影剂显示及充盈增强程度,分别以静息状态下MCE的心肌造影计分(MCS)为2～3分、腺苷负荷后MCS≥2或者造影强度改善≥1分判断为存活心肌进行分析。血运重建术后3个月复查心脏超声并与术前做比较,以室壁运动改善≥1分作为判断存在存活心肌的标准。结果冠脉血运重建3个月后,室壁运动有245个节段(存活)改善,无改善有91个节段(不存活)。回顾分析显示:静息状态下MCE评价为存活心肌节段有196个(其中术后运动改善节段有174个,不改善节段22个)、不存活心肌节段140个(其中术后运动改善节段64个,无改善节段76个)。负荷MCE评价的存活心肌节段有238个(其中术后运动改善节段225个,不改善节段13个)、不存活心肌节段98个(其中术后运动有改善节段16个,无改善节段82个),静息状态MCE评判存活心肌的敏感性、特异性及准确率分别为73. 11%、77. 55%、74. 1%,负荷MCE评价存活心肌的敏感性、特异性及准确率分别为93. 36%、86. 31%、91. 3%。结论腺苷负荷下的MCE能较准确、便捷并可视化评价存活心肌,这对冠心病患者临床治疗方案的确立以及及冠状动脉血运重建后的疗效观察等都有十分重要的协助和指导价值。
Objective To evaluate the clinical value of myocardial contrast echocardiography( MCE) in combination with adenosine stress test in the detection of viable myocardium in patients with myocardial infarction. Methods 45 cases of patients with coronary heart disease who were diagnosed clinically and planned to receive coronary revascularization,were selected.Routine echocardiography showed totally 336 segments of left ventricular wall with abnormal movement.MCE was conducted no more than24 hours before revascularization,contrast presenting and filing enhancement degree in myocardial microcirculation of ventricular regions with abnormal movement under rest state and after venous administration of adenosine,were observed and recorded.Viable myocardium was differentiated by 2 to 3 scores in MCE scale( MCS) under rest state,MCS ≥ 2 scores under adenosine stress or MCS improvement ≥ 1 score.Reexamination of echocardiography was conducted 3 months after revascularization.The results were compared with those before treatment and MCS improvement ≥ 1 score was used as the standard to judge whether there was viable myocardium.Results 3 months after coronary revascularization,ventricular wall motion of 245 segments( viable) improved,while the other 91 segments( unviable) did not.Retrospective analysis showed that under rest state,there were 196 segments assessed as viable myocardium( including 174 segments acquiring improvement after operation and 22 segments not improved) and 140 segments assessed as unviable myocardium( including 64 segments with post-operation improvement and 76 segments without),while under adenosine stress,there were 238 segments assessed by MCE as viable myocardium( including 225 segments with post-operation improvement and 13 segments without) and 98 segments assessed as unviable myocardium( including 16 segments with post-operation improvement and 82 segments without).In the assessment of viable myocardium,MCE under rest state had a sensitivity of 73. 11%,a specificity of 77. 55% and an accuracy of 74. 1%,while MCE under adenosine stress had a sensitivity of93. 36%,a specificity of 86. 31% and an accuracy of 91. 3%.Conclusion MCE under adenosine stress is accurate,convenient and visible,which has important significance in establishing treatment programs for patients with coronary heart disease and observing therapeutic effects after coronary revascularization.
Objective To evaluate the clinical value of myocardial contrast echocardiography( MCE) in combination with adenosine stress test in the detection of viable myocardium in patients with myocardial infarction. Methods 45 cases of patients with coronary heart disease who were diagnosed clinically and planned to receive coronary revascularization,were selected.Routine echocardiography showed totally 336 segments of left ventricular wall with abnormal movement.MCE was conducted no more than24 hours before revascularization,contrast presenting and filing enhancement degree in myocardial microcirculation of ventricular regions with abnormal movement under rest state and after venous administration of adenosine,were observed and recorded.Viable myocardium was differentiated by 2 to 3 scores in MCE scale( MCS) under rest state,MCS ≥ 2 scores under adenosine stress or MCS improvement ≥ 1 score.Reexamination of echocardiography was conducted 3 months after revascularization.The results were compared with those before treatment and MCS improvement ≥ 1 score was used as the standard to judge whether there was viable myocardium.Results 3 months after coronary revascularization,ventricular wall motion of 245 segments( viable) improved,while the other 91 segments( unviable) did not.Retrospective analysis showed that under rest state,there were 196 segments assessed as viable myocardium( including 174 segments acquiring improvement after operation and 22 segments not improved) and 140 segments assessed as unviable myocardium( including 64 segments with post-operation improvement and 76 segments without),while under adenosine stress,there were 238 segments assessed by MCE as viable myocardium( including 225 segments with post-operation improvement and 13 segments without) and 98 segments assessed as unviable myocardium( including 16 segments with post-operation improvement and 82 segments without).In the assessment of viable myocardium,MCE under rest state had a sensitivity of 73. 11%,a specificity of 77. 55% and an accuracy of 74. 1%,while MCE under adenosine stress had a sensitivity of93. 36%,a specificity of 86. 31% and an accuracy of 91. 3%.Conclusion MCE under adenosine stress is accurate,convenient and visible,which has important significance in establishing treatment programs for patients with coronary heart disease and observing therapeutic effects after coronary revascularization.
引文
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[9]Ana Djordjevic-Dikic,Miodrag Ostojic,Branko Beleslin,et al.Low-dose adenosine stress echocardiography Detection of myocardial viability[J].Cardiovascular Ultrasound,2003,1:1-7.
[10]赵京林,杨跃进,荆志成,等.腺苷对猪急性心肌梗死再灌注后无再流的影响[J].中华心血管病杂志,2005,33(5):453-458.
[11]冉红,张平洋,张幼祥,等.三维斑点追踪成像评价心肌存活性的临床研究[J].中华急诊医学杂志,2014,23(7):867-872.
[2]邢爽,李玉宏,吴存刚,等.实时三维超声心动图评价缺血性心脏病患者左室节段收缩功能的研究[J].山东医药,2010,50(52):50-51.
[3]吴迪,张红超,姚克纯,等.心肌声学造影对冠状动脉血运重建术心肌灌注的评价研究[J].中国循证心血管医学杂志,2013,5(1):43-45.
[4]Fernandes DR,Tsutsui JM,Bocchi EA,et al.Qualitative and quantitative real time myocardial contrast echocardiography for detecting hibernating myocardium[J].Echocardiography,2011,28(3):342-349.
[5]王震,郑波,李宗清,等.心肌声学造影评价非ST段抬高型心肌梗死患者PCI术后心功能[J].中国老年医学杂志,2016,36(10):5030-5031.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2009,37(1):4-25.
[7]汤裕华,钱建芬,林银康,等.实时心肌声学造影评价急性心肌梗死介入治疗后心肌灌注状况对其长期疗效的影响[J].实用医学杂志,2012,28(23):3883-3885.
[8]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.
[9]Ana Djordjevic-Dikic,Miodrag Ostojic,Branko Beleslin,et al.Low-dose adenosine stress echocardiography Detection of myocardial viability[J].Cardiovascular Ultrasound,2003,1:1-7.
[10]赵京林,杨跃进,荆志成,等.腺苷对猪急性心肌梗死再灌注后无再流的影响[J].中华心血管病杂志,2005,33(5):453-458.
[11]冉红,张平洋,张幼祥,等.三维斑点追踪成像评价心肌存活性的临床研究[J].中华急诊医学杂志,2014,23(7):867-872.