CAJ | 학술논문

目的比较实时心肌声学造影(RTMCE)和间歇触发心肌声学造影(ITMCE)检测急性心肌梗死再灌注后心肌无复流的准确率.方法 30只中华小型猪,通过心导管介入法建立急性心肌梗死再灌注模型.在基础状态、前降支闭塞2 h及开通后3 h分别行RTMCE和ITMCE.以冠状动脉闭塞2 h的心肌充盈缺损面积为危险区心肌面积(RA),再灌注3 h的心肌充盈缺损面积为无复流面积(NRA),计算二者比值(NRA/RA),并与病理染色确定的NRA/RA进行比较.结果 RTMCE、ITMCE和病理染色测定的NRA/RA分别为(47.94±21.29)%、(38.20±21.04)%和(30.07±14.62)%.其中ITMCE与病理染色、RTMCE与ITMCE测定的NRA/RA比值差异无统计学意义(P=0.124、0.071).RTMCE、ITMCE均与病理染色程度呈正相关 (r=0.700、P<0.001和r=0.765、P<0.001),RTMCE与ITMCE同样呈正相关(r=0.897,P<0.001).RTMCE和ITMCE检测心肌无复流的灵敏度、特异度和准确率分别为100%、58.33%、79.17%和91.67%、73.33%、81.48%.结论 RTMCE和ITMCE可无创显示心肌灌注状态, 并定量检测缺血再灌注后的心肌无复流现象.
목적 비교실시심기성학조영(RTMCE)화간헐촉발심기성학조영(ITMCE)검측급성심기경사재관주후심기무복류적준학솔.방법 30지중화소형저,통과심도관개입법건립급성심기경사재관주모형.재기출상태、전강지폐새2 h급개통후3 h분별행RTMCE화ITMCE.이관상동맥폐새2 h적심기충영결손면적위위험구심기면적(RA),재관주3 h적심기충영결손면적위무복류면적(NRA),계산이자비치(NRA/RA),병여병리염색학정적NRA/RA진행비교.결과 RTMCE、ITMCE화병리염색측정적NRA/RA분별위(47.94±21.29)%、(38.20±21.04)%화(30.07±14.62)%.기중ITMCE여병리염색、RTMCE여ITMCE측정적NRA/RA비치차이무통계학의의(P=0.124、0.071).RTMCE、ITMCE균여병리염색정도정정상관 (r=0.700、P<0.001화r=0.765、P<0.001),RTMCE여ITMCE동양정정상관(r=0.897,P<0.001).RTMCE화ITMCE검측심기무복류적령민도、특이도화준학솔분별위100%、58.33%、79.17%화91.67%、73.33%、81.48%.결론 RTMCE화ITMCE가무창현시심기관주상태, 병정량검측결혈재관주후적심기무복류현상.
Objective To assess the value of real-time myocardial contrast echocardiography (RTMCE) and intermittent triggered myocardial contrast echocardiography (ITMCE) in the detection of myocardial no-reflow phenomenon after reperfusion in acute myocardial infarction on mini-swine models. Methods Thirty close-chest mini-swines were used to create acute myocardial infarction and reperfusion model through interventional method. RTMCE and ITMCE were performed at baseline, 2 h after occlusion of left anterior descending coronary artery and 3 h after reperfusion. The myocardial perfusion defects after occlusion was measured as risk area (RA) and that after reperfusion was measured as no-reflow area (NRA). NRA/RA was calculated and compared with pathological findings. Results The whole study protocol was successfully performed in 27 mini-swines. NRA/RA obtained from RTMCE, ITMCE and pathological staining was (47.94±21.29)%, (38.20±21.04)% and (30.07±14.62)% , respectively. NRA/RA had no significant difference by ITMCE and pathological staining (P=0.124), RTMCE and ITMCE (P=0.071). The correlation coefficient of RTMCE and staining was 0.700 (P<0.001), ITMCE and staining was 0.765 (P<0.001), RTMCE and ITMCE was 0.897 (P<0.001). The sensitivity, specificity and accuracy in the detection of myocardial no-reflow was 100%, 58.33% and 79.17% for RTMCE, 91.67%, 73.33% and 81.48% for ITMCE. Conclusion Both RTMCE and ITMCE could be used as noninvasive methods to reveal the myocardial perfusion and quantitatively detect myocardial no-reflow after reperfusion therapy.