CAJ | 학술논문

目的探讨二维应变成像结合腺苷负荷超声心动图评价存活心肌的新方法.方法 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,建立急性心肌梗死再灌注模型.分别于基础状态下(结扎前)和再灌注后采集心尖三腔、两腔和短轴二尖瓣、乳头肌、心尖水平的图像.随后泵入腺苷并重复采集图像.以氯化三苯基四氮唑溶液(2,3,5-triphenyl tetrazolium chloride,TTC)染色结果测量梗死面积(SN)与该节段总面积(S)的百分比(SN/S),SN/S≤50%即为存活心肌.将前壁、前间壁各节段分为存活心肌和非存活心肌,运用二维应变成像技术定量评价犬不同状态下存活与非存活心肌径向、纵向及圆周的收缩期峰值应变(peak-systolic strain,Speak sys)并进行比较.结果存活与非存活心肌分别为37和53个节段.(1)基础状态下:存活与非存活心肌的收缩期峰值径向应变(RSpeak sys)、纵向应变(LSpeak sys)及圆周应变(CSpeak sys)比较差异无统计学意义.(2)再灌注120 min后:存活与非存活心肌的RSpeak sys、LSpeak sys及CSpeak sys(绝对值)均低于基础状态,而存活心肌与非存活心肌组间差异无统计学意义.(3)腺肾负荷后:与再灌注120 min后相比,存活心肌的RSpeak sys、LSpeak sys显著升高(P<0.01或P<0.05),且存活心肌的RSpeak sys、LSpeak sys明显高于非存活心肌(P<0.01).(4)腺苷负荷后,RSpeak sys与SN/S呈负相关(r=-0.72,P<0.01),CSpeak sys及LSpeak sys与SN/S呈正相关(r值分别为0.40和0.67,P均<0.01).(5)将腺苷负荷前、后应变数值的变化率(△RSpeak sys和△LSpeak sys)作为研究对象,以△RSpeak sys≥13.5%作为判断心肌存活的最佳截断值,其识别存活心肌的敏感性和特异性分别为83.8%、83.0%;以△LSpeak sys≥11%作为最佳截断值,其敏感性和特异性分别为78.4%、88.7%;联合△RSpeak sys和△LSpeak sys两项指标,其敏感性和特异性分别为91.9%、79.2%.结论二维应变成像技术结合腺苷负荷超声心动图能比较准确地区分存活心肌与非存活心肌. 目的探討二維應變成像結閤腺苷負荷超聲心動圖評價存活心肌的新方法.方法 15隻健康雜種犬,結扎其冠狀動脈前降支90 min後,恢複血流灌註120 min,建立急性心肌梗死再灌註模型.分彆于基礎狀態下(結扎前)和再灌註後採集心尖三腔、兩腔和短軸二尖瓣、乳頭肌、心尖水平的圖像.隨後泵入腺苷併重複採集圖像.以氯化三苯基四氮唑溶液(2,3,5-triphenyl tetrazolium chloride,TTC)染色結果測量梗死麵積(SN)與該節段總麵積(S)的百分比(SN/S),SN/S≤50%即為存活心肌.將前壁、前間壁各節段分為存活心肌和非存活心肌,運用二維應變成像技術定量評價犬不同狀態下存活與非存活心肌徑嚮、縱嚮及圓週的收縮期峰值應變(peak-systolic strain,Speak sys)併進行比較.結果存活與非存活心肌分彆為37和53箇節段.(1)基礎狀態下:存活與非存活心肌的收縮期峰值徑嚮應變(RSpeak sys)、縱嚮應變(LSpeak sys)及圓週應變(CSpeak sys)比較差異無統計學意義.(2)再灌註120 min後:存活與非存活心肌的RSpeak sys、LSpeak sys及CSpeak sys(絕對值)均低于基礎狀態,而存活心肌與非存活心肌組間差異無統計學意義.(3)腺腎負荷後:與再灌註120 min後相比,存活心肌的RSpeak sys、LSpeak sys顯著升高(P<0.01或P<0.05),且存活心肌的RSpeak sys、LSpeak sys明顯高于非存活心肌(P<0.01).(4)腺苷負荷後,RSpeak sys與SN/S呈負相關(r=-0.72,P<0.01),CSpeak sys及LSpeak sys與SN/S呈正相關(r值分彆為0.40和0.67,P均<0.01).(5)將腺苷負荷前、後應變數值的變化率(△RSpeak sys和△LSpeak sys)作為研究對象,以△RSpeak sys≥13.5%作為判斷心肌存活的最佳截斷值,其識彆存活心肌的敏感性和特異性分彆為83.8%、83.0%;以△LSpeak sys≥11%作為最佳截斷值,其敏感性和特異性分彆為78.4%、88.7%;聯閤△RSpeak sys和△LSpeak sys兩項指標,其敏感性和特異性分彆為91.9%、79.2%.結論二維應變成像技術結閤腺苷負荷超聲心動圖能比較準確地區分存活心肌與非存活心肌.
목적 탐토이유응변성상결합선감부하초성심동도평개존활심기적신방법.방법 15지건강잡충견,결찰기관상동맥전강지90 min후,회복혈류관주120 min,건립급성심기경사재관주모형.분별우기출상태하(결찰전)화재관주후채집심첨삼강、량강화단축이첨판、유두기、심첨수평적도상.수후빙입선감병중복채집도상.이록화삼분기사담서용액(2,3,5-triphenyl tetrazolium chloride,TTC)염색결과측량경사면적(SN)여해절단총면적(S)적백분비(SN/S),SN/S≤50%즉위존활심기.장전벽、전간벽각절단분위존활심기화비존활심기,운용이유응변성상기술정량평개견불동상태하존활여비존활심기경향、종향급원주적수축기봉치응변(peak-systolic strain,Speak sys)병진행비교.결과 존활여비존활심기분별위37화53개절단.(1)기출상태하:존활여비존활심기적수축기봉치경향응변(RSpeak sys)、종향응변(LSpeak sys)급원주응변(CSpeak sys)비교차이무통계학의의.(2)재관주120 min후:존활여비존활심기적RSpeak sys、LSpeak sys급CSpeak sys(절대치)균저우기출상태,이존활심기여비존활심기조간차이무통계학의의.(3)선신부하후:여재관주120 min후상비,존활심기적RSpeak sys、LSpeak sys현저승고(P<0.01혹P<0.05),차존활심기적RSpeak sys、LSpeak sys명현고우비존활심기(P<0.01).(4)선감부하후,RSpeak sys여SN/S정부상관(r=-0.72,P<0.01),CSpeak sys급LSpeak sys여SN/S정정상관(r치분별위0.40화0.67,P균<0.01).(5)장선감부하전、후응변수치적변화솔(△RSpeak sys화△LSpeak sys)작위연구대상,이△RSpeak sys≥13.5%작위판단심기존활적최가절단치,기식별존활심기적민감성화특이성분별위83.8%、83.0%;이△LSpeak sys≥11%작위최가절단치,기민감성화특이성분별위78.4%、88.7%;연합△RSpeak sys화△LSpeak sys량항지표,기민감성화특이성분별위91.9%、79.2%.결론 이유응변성상기술결합선감부하초성심동도능비교준학지구분존활심기여비존활심기.
Objective To explore the feasibility of evaluating viable myocardium with twodimensional strain imaging combined with adenosine stress echocardiography. Methods Acute myocardial infarction and reperfusion model was made by ligating anterior descending coronary artery for 90 minutes followed by 120-minute reperfusion in 15 healthy mongrel dogs. Images were acquired at baseline and after reperfusion Adenosine was then infused and image acquisition repeated. Regional peak-systolic strain in radial, circumferential and longitudinal motion on anterior wall and anterior septum were measured. TTC staining served as a "gold standard" to define viable and nonviable myocardium. The ratio of infarct area ( SN ) to total area (S) was calculated and viable myocardium was defined with SN/S ≤ 50%. Results At baseline, RSpeak sys, CSpeak sys and LSpeak syswere similar between viable ( n = 37 ) and nonviable myocardial segments (n = 53 ) and significantly decreased after reperfusion in both viable and nonviable myocardial segments. Compared with values obtained after reperfusion, LSpeak sys and RSpeak sys remained unchanged in nonviable myocardial segments and significantly increased in viable myocardial segments after adenosine (P<0.05). Post adenosine RSpeak sys was negatively correlated with SN/S and CSpeak sys and LSpeak syswere positively correlated with SN/S. With △RSpeak sys(before and after adenosine) ≥ 13.5%, the sensitivity was 83.8% and specificity was 83.0% for distinguishing viable from nonviable myocardial segment. With △LSpeak sys≥11% as cutoff value, the sensitivity was 78.4% and specificity was 88.7% for distinguishing viable from nonviable myocardial segment. Combining △RSpeak sys and △LSpeak sys, the sensitivity and specificity for distinguishing viable from nonviable myocardial segment were 91.9% and 79. 2%,respectively. Conclusions Two-dimensional strain imaging combined with adenosine stress echocardiography could quantitatively identify viable and nonviable myocardium.