CAJ | 학술논문

目的：探讨运用二维斑点追踪技术（Two-dimensional Speckle Tracking Imaging，2DSTI）结合腺苷负荷超声心动图，观察心肌梗死患者心肌旋转运动、评价其存活性的可行性。方法选择35例陈旧性心肌梗死患者在静息状态及腺苷作用(140μg?kg-1?min-1，持续6 min)下，观察其左心室各节段峰值旋转角度（Peak Rotation，PRot）及收缩期峰值旋转率（Peak-systole Rotation Rate，PRRs）。以核素心肌灌注/代谢显像结果作为金标准，将各节段划分为存活及非存活心肌进行比较研究。结果在基础状态下，存活组与非存活组间的二尖瓣及心尖水平心肌PRot、PRRs无显著性差异（P>0.05）。腺苷负荷后，存活组二尖瓣及心尖水平心肌PRot、PRRs（绝对值）均明显升高，而非存活组的二尖瓣及心尖水平心肌PRot、PRRs无显著性变化。以腺苷负荷后△PRot（%）≥14.5%作为截断值、识别存活心肌的敏感性和特异性分别为91.26%（115/126）、88.23%（90/102）；以腺苷负荷后△PRRs（%）≥18.5%作为最佳截断值，其识别存活心肌的敏感性和特异性分别为88.89%（113/126）、86.27%（88/102）；联合△PRot（%）与△PRRs（%）两项指标，其敏感性和特异性分别为94.41%（119/126）、90.19%（92/102）。结论二维斑点追踪成像结合腺苷负荷超声心动图观察心肌旋转运动，可以作为一种识别心肌梗死患者存活心肌较可靠的新方法。
목적：탐토운용이유반점추종기술（Two-dimensional Speckle Tracking Imaging，2DSTI）결합선감부하초성심동도，관찰심기경사환자심기선전운동、평개기존활성적가행성。방법선택35례진구성심기경사환자재정식상태급선감작용(140μg?kg-1?min-1，지속6 min)하，관찰기좌심실각절단봉치선전각도（Peak Rotation，PRot）급수축기봉치선전솔（Peak-systole Rotation Rate，PRRs）。이핵소심기관주/대사현상결과작위금표준，장각절단화분위존활급비존활심기진행비교연구。결과재기출상태하，존활조여비존활조간적이첨판급심첨수평심기PRot、PRRs무현저성차이（P>0.05）。선감부하후，존활조이첨판급심첨수평심기PRot、PRRs（절대치）균명현승고，이비존활조적이첨판급심첨수평심기PRot、PRRs무현저성변화。이선감부하후△PRot（%）≥14.5%작위절단치、식별존활심기적민감성화특이성분별위91.26%（115/126）、88.23%（90/102）；이선감부하후△PRRs（%）≥18.5%작위최가절단치，기식별존활심기적민감성화특이성분별위88.89%（113/126）、86.27%（88/102）；연합△PRot（%）여△PRRs（%）량항지표，기민감성화특이성분별위94.41%（119/126）、90.19%（92/102）。결론이유반점추종성상결합선감부하초성심동도관찰심기선전운동，가이작위일충식별심기경사환자존활심기교가고적신방법。
Objective To explore a new method to evaluate myocardium viability by two-dimensional speckle tracking imaging (2DSTI) combined with adenosine stress echocardiography in the patients with myocardial infarction. Methods The regional peak rotation (PRot) and peak-systole rotation rate (PRRs) of each segment were detected using 2DSTI in 35 cases of patients with elderly myocardial infarction at rest and adenosine (140μg?kg-1?min-1, continuing 6 min). And then, every corresponding segment were deifned as viable or non-viable myocardium according to radionuclide myocardial perfusion/metabolic imaging. Results At baseline, there was no signiifcant difference in PRot and PRRs between viable and nonviable myocardium segments. And under adenosine stress, PRot and PRRs of myocardial segments at the mitral or apical levels in viable group increased signiifcantly while didn’t change remarkably in the nonviable in contrast with those at rest. Compared with those in nonviable group, PRot and PRRs of myocardial segments at mitral or apical levels in viable group increased signiifcantly respectively. Using a cutoff of 14.5%,△PRot had a sensitivity of 91.26%and speciifcity of 88.23%for distinguishing viable from nonviable segment. Using a cutoff of 18.5%,△PRRs had a sensitivity of 88.89%and speciifcity of 86.27%for distinguishing viable from nonviable segment. Combined with PRot and PRRs, the sensitivity and speciifcity could reach 94.41%and 90.19%. Conclusion Speckle tracking imaging combined with adenosine stress echocardiography could provide a reliable and new method for identifying viable myocardium from evaluating myocardium rotation motion.