CAJ | 학술논문

目的探寻应用定量组织速度成像(QTVI)与组织追踪(TT)结合腺苷负荷超声心动图试验评价心肌存活性的新方法.方法选取15只健康杂种犬,结扎其冠状动脉前降支90 min后恢复血流灌注120 min制作急性心肌梗死再灌注模型.应用QTVI及TT评价不同状态下前壁、前间隔收缩期峰值运动速度(Vs)、等容收缩期峰值运动速度(VIVC)以及收缩期最大位移(Ds)三个指标的变化.以氯化三苯基四氮唑(2,3,5-triphenyl tetrazoliurn chloride,TTC)染色结果作为金标准,将前壁、前间隔各节段划分为存活组及非存活组心肌.两组间比较采用t检验,同组前后不同状态下数据比较采用方差分析和LSD-t检验.描绘ROC曲线并计算△Vs%和△Ds%识别存活心肌的最佳截断值.结果与基础状态下比较,再灌注120min时存活组及非存活组心肌Vs、Vrvc、Ds均明显减低(P＜0.01);与再灌注120min时比较,腺苷负荷后,存活组心肌Vs、Ds升高(P＜0.05),而VIVC无显著性变化(P＞0.05),非存活组心肌各项指标负荷前后差异均无统计学意义(P＞0.05).ROC曲线判定,以存活组心肌腺苷负荷后△Vs(%)≥17.9作为最佳截断值,则QTVI结合腺苷负荷超声心动图识别存活心肌的敏感性和特异性分别为78.6%,81.1%;以存活组心肌腺苷负荷后△Ds(%)≥18.4作为最佳截断值,则TT结合腺苷负荷超声心动图识别存活心肌的敏感性和特异性分别为75.0%,83.8%.联合△Vs%和△Ds%两项指标,预测心肌存活性的敏感性和特异性分别为:94.6%,68.0%.结论 QTVI及TT结合腺苷负荷超声心动网能够提高识别存活心肌的敏感性和特异性,QTVI及TT指标相结合可提高诊断的敏感性.
목적 탐심응용정량조직속도성상(QTVI)여조직추종(TT)결합선감부하초성심동도시험평개심기존활성적신방법.방법 선취15지건강잡충견,결찰기관상동맥전강지90 min후회복혈류관주120 min제작급성심기경사재관주모형.응용QTVI급TT평개불동상태하전벽、전간격수축기봉치운동속도(Vs)、등용수축기봉치운동속도(VIVC)이급수축기최대위이(Ds)삼개지표적변화.이록화삼분기사담서(2,3,5-triphenyl tetrazoliurn chloride,TTC)염색결과작위금표준,장전벽、전간격각절단화분위존활조급비존활조심기.량조간비교채용t검험,동조전후불동상태하수거비교채용방차분석화LSD-t검험.묘회ROC곡선병계산△Vs%화△Ds%식별존활심기적최가절단치.결과 여기출상태하비교,재관주120min시존활조급비존활조심기Vs、Vrvc、Ds균명현감저(P＜0.01);여재관주120min시비교,선감부하후,존활조심기Vs、Ds승고(P＜0.05),이VIVC무현저성변화(P＞0.05),비존활조심기각항지표부하전후차이균무통계학의의(P＞0.05).ROC곡선판정,이존활조심기선감부하후△Vs(%)≥17.9작위최가절단치,칙QTVI결합선감부하초성심동도식별존활심기적민감성화특이성분별위78.6%,81.1%;이존활조심기선감부하후△Ds(%)≥18.4작위최가절단치,칙TT결합선감부하초성심동도식별존활심기적민감성화특이성분별위75.0%,83.8%.연합△Vs%화△Ds%량항지표,예측심기존활성적민감성화특이성분별위:94.6%,68.0%.결론 QTVI급TT결합선감부하초성심동망능구제고식별존활심기적민감성화특이성,QTVI급TT지표상결합가제고진단적민감성.
Objective To seek a new method to identify viability of myocardium by adenosine stress echocardiography combined with quantitative tissue velocity imaging(QTVI)and tissue tracking(TT).Methods Fifteen healthy canines were selected to establish the models of acute myocardial infarction and reperfusion by ligating anterior descending branch of coronary artery for 90 minutes and then releasing the artery to get reperfusion.After reperfusion.peak velocity in systole(Vs),peak velocity in isovolumic contraction(VIVC)and the displacement in systole(Ds)were measured on anterior wall and anterior septum at baseline.The 2,3,5-triphenyl tetrazolium chloride(TTC)staining was set as a"gold standard"for defining the viable and non-viable groups.The sensitivity and specificity of assessing myocardial viability were determined with QTVI and TT.Comparison of variables between viable and non-viable group was made by using t test.One way analysis of variance and LSD-t test were used to estimate the significance of differences in different states.Results Compared with baseline,Vs,VIVC and Ds decreased significantly(P＜0.01)after reperfusion in both viable and non-viable group.After administration of adenosine,Vs and Ds increased(P＜0.05),but VIVC didn't change significantly compared with that before administration of adenosine in viable group(P＞0.05).Variables in non-viable group didn't change significantly after administration of adenosine(P＞0.05).By receiver operating characteristic(ROC)analysis for predicting myocardial viability,when a cutoff value of △Vs(%)rate was 17.9,the sensitivity and the specificity was 78.6%and 81.1%,respectively,and when the cutoff value of △Ds(%)rate was 18.4,the sensitivity and the specificity was 75.0%,83.6%,respectively.Combined △Vs(%)with △Ds(%),the sensitivity and specificity to prediction of myocardium viability could reach 94.6%and 68.0%,respectively.Conclusions When the viability of myocardium after myocardial infarction is assessed by using the method of adenosine stress echocardiography with QTVI and TT,the sensitivity and the specificity are greatly enhanced.