CAJ | 학술논문

目的评价定量腺苷负荷超声心动图技术诊断冠心病的准确性.方法 40例患者行常规剂量(140μg·ks-1·min-1持续6 min静脉滴注)腺苷负荷超声心动图试验以评估心肌缺血.基于常规二维图像之上的组织多普勒成像采集基线状态和药物负荷状态下的心肌运动图像(美国GE VIVID7超声诊断仪),在ECHOPAC软件上进行后处理分析测量16节段心肌运动速度、应变、应变率.结果以冠状动脉造影或CT冠状动脉成像为标准,共有缺血节段159个节段,非缺血节段465个.腺苷负荷峰值后,除缺血心肌的舒张早期应变(Se)无明显变化外,缺血心肌和非缺血心肌的收缩期速度(Sm)、舒张早期速度(Em)、舒张晚期速度(Am)和收缩期应变(Smax)以及收缩期应变率(SRs)、舒张早期应变率(SRe)、舒张晚期应变率(SRa),以及非缺血心肌的舒张早期应变(Se)均明显增加(P＜0.05).缺血心肌的基线Sm和Em均显著低于非缺血心肌[分别为(3.16±1.20)cm/s和(4.03±1.27)cm/s,P＜0.01;(3.75±1.67)cm/s和(4.66±1.70)cm/s,P＜0.05],峰值负荷下,两组间Sm和Em差异更加显著[分别为(3.98±1.63)cm/s和(5.07±1.52)cm/s;(4.51±2.32)cm/s和(6.52±2.56)cm/s;均P＜0.01];缺血心肌的收缩期应变(Smax)和舒张早期应变(Se)均明显低于非缺血心肌(分别为16.91%±3.35%和19.56%±5.47%,P＜0.01;9.53%±2.89%和13.06%±4.63%,P＜0.001).操作者工作特性(ROC)曲线所得曲线下面积以负荷峰值的Se最大(曲线下面积=0.740,敏感性为67%,特异性为83%).结论组织多普勒负荷超声心动图参数可定量评估心肌缺血,是临床非创伤性诊断冠心病准确可靠的方法.
목적 평개정량선감부하초성심동도기술진단관심병적준학성.방법 40례환자행상규제량(140μg·ks-1·min-1지속6 min정맥적주)선감부하초성심동도시험이평고심기결혈.기우상규이유도상지상적조직다보륵성상채집기선상태화약물부하상태하적심기운동도상(미국GE VIVID7초성진단의),재ECHOPAC연건상진행후처리분석측량16절단심기운동속도、응변、응변솔.결과 이관상동맥조영혹CT관상동맥성상위표준,공유결혈절단159개절단,비결혈절단465개.선감부하봉치후,제결혈심기적서장조기응변(Se)무명현변화외,결혈심기화비결혈심기적수축기속도(Sm)、서장조기속도(Em)、서장만기속도(Am)화수축기응변(Smax)이급수축기응변솔(SRs)、서장조기응변솔(SRe)、서장만기응변솔(SRa),이급비결혈심기적서장조기응변(Se)균명현증가(P＜0.05).결혈심기적기선Sm화Em균현저저우비결혈심기[분별위(3.16±1.20)cm/s화(4.03±1.27)cm/s,P＜0.01;(3.75±1.67)cm/s화(4.66±1.70)cm/s,P＜0.05],봉치부하하,량조간Sm화Em차이경가현저[분별위(3.98±1.63)cm/s화(5.07±1.52)cm/s;(4.51±2.32)cm/s화(6.52±2.56)cm/s;균P＜0.01];결혈심기적수축기응변(Smax)화서장조기응변(Se)균명현저우비결혈심기(분별위16.91%±3.35%화19.56%±5.47%,P＜0.01;9.53%±2.89%화13.06%±4.63%,P＜0.001).조작자공작특성(ROC)곡선소득곡선하면적이부하봉치적Se최대(곡선하면적=0.740,민감성위67%,특이성위83%).결론 조직다보륵부하초성심동도삼수가정량평고심기결혈,시림상비창상성진단관심병준학가고적방법.
Objective To evaluate the value of adenosine tissue Doppler stress eehoeardiography on ischemic myocardium.Methods Routine dosage (140 μg· kg-1 · min-1 IV for 6 min) adenosine stress echocardiography was performed on 40 patients with chest pain for diagnosis of coronary artery disease (CAD).The images of left ventricular myocardial motion were acquired by tissue Doppler imaging (TDI)based on traditional 2D stress ochocardiography before and 3 min,6 rain after adenosine stress (GE Vivid 7,USA).The myocardial velocity,strain and strain rate in 16 segments were offline measured and analyzed on ECHOPAC software.The results were compared with that of coronary angiography (CAG).Results CAG identified 18 CAD and 22 non-CAD patients with 159 ischemie segments and 465 non-ischemic segments.Adenosine significantly increased the systolic velocity (Sm),early diastolic velocity (Em),late diastolic velocity (Am),peak systolic strain (Smax),systolic strain rate (SRs),early diastolic strain rate (SRe)and late diastolic strain rate (SRa) both iachemic and non-ischemic segments (all P＜0.05).The baseline Sm and Em in isehemic segments were significant lower than non-ischemic segments [(3.16±1.20) cm/svs (4.03+1.27) cm/s,P＜0.01;(3.75±1.67) cm/s vs (4.66±1.70) orals,P＜0.05].At peak stress the differences in Sm and Em were mere significant [(3.98±1.63) cm/s vs (5.07±1.52) cm/s;(4.51±2.32) cm/s vs (6.52±2.56) cm/s;P＜0.01].The reductions on Smax and Se were more significant in isehemic segments compared those in non-isehemic segments (16.91% ±3.35% vs 19.56%±5.47%,P＜0.01 and 9.53%±2.89% vs 13.06% ±4.63%,P＜0.001).The biggest area under curve (AUG) in peak stress was seen in Se by ROC curve analysis (AUG=0.740,with sensitivity 67%and specificity 83%).Conclusion Parameters derived from TDI offer reliable and accurate information on ischemic myocardium during adenosine stress echocardiography.