CAJ | 학술논문

目的探讨二维斑点追踪成像技术结合腺苷负荷超声心动图评价心肌存活性的临床价值.方法应用二维超声心动图观察39例心肌梗死患者心肌运动,二维斑点追踪成像技术分别检测患者静息状态和腺苷负荷(140 μg· kg-1·min-1)作用下各节段径向、纵向及环向收缩期峰值应变(RSpeak-sys、LSpeak-sys、CSpeak-sys),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组及非存活组心肌.结果 (1)总共624心肌节段中,368节段表现为运动异常,其中存活心肌215节段,非存活心肌153节段.(2)静息状态下,存活与非存活心肌组间各指标差异均无统计学意义；腺苷负荷后,存活组的RSeak-sys[(37.98±5.45)％比(30.22 ±5.47)％]及LSpeak-sys[(-23.71 ±4.53)％比(-17.52 ±4.34)％]较其静息状态下明显增加(P＜0.05),而非存活组各指标变化差异无统计学意义(P＞0.05)；存活组与非存活组的RSpeak-sys[分别为(37.98 ±5.45)％和(30.12±5.37)％]、LSpeak-sys[分别为(-23.71 ±4.53)％和(-16.95 ±4.62)％]变化差异有统计学意义(P＜0.05),而CSpeak-sys变化差异无统计学意义(P＞0.05).(3)以RSpeak-sys、LSpeak-sys作为观察对象,腺苷负荷状态下RSpeak-sys增加＞9.8％评价存活心肌的敏感度为82.3％,特异度为81.1％；LSpeak-sys增加＞16.5％评判存活心肌的敏感度为83.5％,特异度为92.3％.结论二维斑点追踪成像技术结合腺苷负荷超声心动图能够为临床提供有效区分存活与非存活心肌的新途径.
목적 탐토이유반점추종성상기술결합선감부하초성심동도평개심기존활성적림상개치.방법 응용이유초성심동도관찰39례심기경사환자심기운동,이유반점추종성상기술분별검측환자정식상태화선감부하(140 μg· kg-1·min-1)작용하각절단경향、종향급배향수축기봉치응변(RSpeak-sys、LSpeak-sys、CSpeak-sys),이핵소심기관주/대사현상결과작위금표준장각절단화분위존활조급비존활조심기.결과 (1)총공624심기절단중,368절단표현위운동이상,기중존활심기215절단,비존활심기153절단.(2)정식상태하,존활여비존활심기조간각지표차이균무통계학의의；선감부하후,존활조적RSeak-sys[(37.98±5.45)％비(30.22 ±5.47)％]급LSpeak-sys[(-23.71 ±4.53)％비(-17.52 ±4.34)％]교기정식상태하명현증가(P＜0.05),이비존활조각지표변화차이무통계학의의(P＞0.05)；존활조여비존활조적RSpeak-sys[분별위(37.98 ±5.45)％화(30.12±5.37)％]、LSpeak-sys[분별위(-23.71 ±4.53)％화(-16.95 ±4.62)％]변화차이유통계학의의(P＜0.05),이CSpeak-sys변화차이무통계학의의(P＞0.05).(3)이RSpeak-sys、LSpeak-sys작위관찰대상,선감부하상태하RSpeak-sys증가＞9.8％평개존활심기적민감도위82.3％,특이도위81.1％；LSpeak-sys증가＞16.5％평판존활심기적민감도위83.5％,특이도위92.3％.결론이유반점추종성상기술결합선감부하초성심동도능구위림상제공유효구분존활여비존활심기적신도경.
Objective Rcgional lcft vcntricular (LV) function could be detected by measuring peak-systolic strain by speckle tracking imaging (STI).We evaluated the value of STI combined with adenosine stress echocardiography on assessing myocardial viability in patients with myocardial infarction (MI).Methods Two dimensional echocardiography was performed at rest and after adenosine stress echocardiography (infused at 140 μg · kg-1 · min-1 over a period of 6 min) in 39 stable patients with previous MI.Peak-systolic (Speak-sys) circumferential strain,radial strain and longitudinal strain were assessed by STI.Radionuclide myocardial perfusion/metabolic imaging served as the “gold standard” to detection of myocardial viability.Results (1) There were 215 viable and 153 non-viable regions among 368abnormal motion segments out of 624 segments in 39 MI patients according to radionuclide imaging results.(2) Speak-sys was similar between viable and nonviable myocardium at rest (all P ＞ 0.05).After adenosine infusion,radial Speak-sys [(37.98 ± 5.45) ％ vs.(30.22 ± 5.47) ％],longitudinal Speak-sys [(-23.71 ±4.53) ％ vs.(-17.52 ± 4.34) ％] increased significantly (P ＜ 0.05) in viable segments compared to baseline levels and were significantly higher than in nonviable segments radial Speak-sys [(37.98 ± 5.45) ％vs.(30.12±5.37)％] and longitudinal Speak-sys[(-23.71 ±4.53)％ vs.(-16.95±4.62)％](P＜0.05),while remained unchanged in nonviable segments before and after adenosine infusion.Circumferential Speak-sys was similar before and after adenosine infusion in both viable and nonviable segments (all P ＞ 0.05).(3) Delta radial strain change ＞ 9.8％ has a sensitivity of 82.3％ and a specificity of 81.1％ whereas a delta change of longitudinal strain ＞ 16.5％ has a sensitivity of 83.5％ and a specificity of 92.3％ for detecting viable segments.Conclusions Speckle tracking imaging combined with adenosine stress echocardiography could serve as a new and reliable method of assessing myocardial viability.