CAJ | 학술논문

目的探讨实时心肌声学造影与二维应变成像技术评价心肌梗死后患者存活心肌的价值.方法 20例准备进行血运重建术心肌梗死患者,于术前1周内行实时心肌造影检查,根据心肌灌注结果进行半定量评价:3分为充盈缺损,2分为回声稀疏不均匀及心内膜下充盈缺损,1分为回声均匀性增强;MCE定义心肌存活性为心肌灌注计分≤2分,而心肌充盈缺损表示无心肌存活性.血运重建术前及术后3个月分别获取心尖位四腔、两腔及左心长轴切面二维图象,进行室壁运动评分,根据术后的室壁运动有否改善分为存活心肌组和无存活心肌组,测定术前左室各节段心肌的收缩期纵向峰值应变.结果 (1) 血运重建术前,二维超声心动图发现共有90个室壁明显发生节段性运动异常,其中有70个室壁的节段性运动异常术后得到改善.(2)血运重建术前,实时心肌声学造影评价存活心肌为65节段,无存活心肌为25节段,敏感性、特异性及准确性分别为93.8%、64%和85.5%.(3) 存活心肌组术前心肌收缩期纵向峰值应变明显高于无存活心肌组[(-7.34±5.84)% vs (-2.11±1.66)%,P＜0.001].以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值判断心肌梗死时存活心肌的敏感性为72%,特异性为85%.结论实时心肌声学造影可以准确地预测梗死心肌的存活性;同时二维应变成像技术以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值也可以预测梗死心肌的存活性,其敏感性和特异性与实时心肌声学造影相当.
목적 탐토실시심기성학조영여이유응변성상기술평개심기경사후환자존활심기적개치.방법 20례준비진행혈운중건술심기경사환자,우술전1주내행실시심기조영검사,근거심기관주결과진행반정량평개:3분위충영결손,2분위회성희소불균균급심내막하충영결손,1분위회성균균성증강;MCE정의심기존활성위심기관주계분≤2분,이심기충영결손표시무심기존활성.혈운중건술전급술후3개월분별획취심첨위사강、량강급좌심장축절면이유도상,진행실벽운동평분,근거술후적실벽운동유부개선분위존활심기조화무존활심기조,측정술전좌실각절단심기적수축기종향봉치응변.결과 (1) 혈운중건술전,이유초성심동도발현공유90개실벽명현발생절단성운동이상,기중유70개실벽적절단성운동이상술후득도개선.(2)혈운중건술전,실시심기성학조영평개존활심기위65절단,무존활심기위25절단,민감성、특이성급준학성분별위93.8%、64%화85.5%.(3) 존활심기조술전심기수축기종향봉치응변명현고우무존활심기조[(-7.34±5.84)% vs (-2.11±1.66)%,P＜0.001].이술전심기수축기종향봉치응변≤-5.0%작위절단치판단심기경사시존활심기적민감성위72%,특이성위85%.결론 실시심기성학조영가이준학지예측경사심기적존활성;동시이유응변성상기술이술전심기수축기종향봉치응변≤-5.0%작위절단치야가이예측경사심기적존활성,기민감성화특이성여실시심기성학조영상당.
Objective We attempted to evaluate myocardial viability in patients with post-myocardial infarction with real-time myocardial contrast echocardiography(RT-MCE)and Two-dimensional strain echocardiography.Methods Intravenous RT-MCE were performed in 20 patients with post-myocardial infarction before revascularization.Myocardial perfusion was assessed by visual interpretation.The results were divided into 3 conditions：contrast defect＝3；partial or reduced opacification or subendocardial contrast defect＝2；homogeneous opacification＝1,presence of viability was defined as the presence of contrast effect(score≤2).Two-dimensional images were recorded from the left ventricular four-chamber view,two-chamber view and the apical view before and after revascularization.According to ventricular wall motion improved after revascularization the patients were divided into viable myocardium group and non-viable myocardium group.The peak systolic longitudinal strain was measured in the apical views before operation.Results (1) 90 significantly abnormal segmental wall motions were found by two-dimensional echocardiography before revascularization,70 out of which were improved postoperation.(2) Viable myocardium group had 65 segments and non-viable myocardium group had 25 segments detected by RT-MCE before revascularization.The sensitivity,specificity and accuracy were 93.8%,64% and 85.5% respectively.(3) The peak systolic longitudinal strain of viable myocardium group were significantly higher than that of the non-viable myocardium group［(-7.34±5.84)% vs (-2.11±1.66)%,P＜0.001］.On taking peak systolic longitudinal strain ≤-5.0% as a cut-off value for detecting survived myocardium,the sensitivity and specificity were 72％ and 85％ respectively.Conclusions RT-MCE can accurately assess myocardial viability.Taking peak systolic longitudinal strain ≤-5.0% as a cut-off value can also assess myocardial viability.Its sensitivity and specificity is in line with the former.