CAJ | 학술논문

目的：探讨小剂量多巴酚丁胺负荷超声(LDDSE)结合心肌背向散射积分(IBS)检测存活心肌的临床应用价值。方法对照组(CON组)18例,冠状动脉定量造影术(QCA)正常,行二维超声(2DE)、LDDSE结合 IBS检查。冠心病组(CAD组)22例,经QCA确诊为冠心病,并行经皮冠脉介入术(PCI),术前1周内行 LDDSE[5μg/(kg· min)、10μg/(kg· min)]检查、静息及硝酸甘油(NTG)介入99m Tc 甲氧基异丁基异腈单光子发射计算机断层灌注显像(SPECT)检查,于静息、DSE每级负荷5 min采集全心尖切面(长轴、二腔、四腔)IBS图像,术后3个月复查二维超声。探索在 LDDSE过程中,以 CVIB最大变化值(K)>0.7定义为存活心肌,检测其识别存活心肌的准确性,并与 LDDSE、SPECT进行比较。结果与 LDDSE相比,LDDSE结合 IBS技术检测存活心肌敏感性、准确性明显提高(91.1% vs 77.8%；90.4% vs 75.7%,P<0.05)；与 SPECT相比敏感性、准确性均明显提高(91.1% vs 80.0%；90.4% vs 76.5%,P<0.05)。结论 LDDSE结合 IBS技术检测存活心肌准确性较 SPECT高,具有临床应用价值。
목적：탐토소제량다파분정알부하초성(LDDSE)결합심기배향산사적분(IBS)검측존활심기적림상응용개치。방법대조조(CON조)18례,관상동맥정량조영술(QCA)정상,행이유초성(2DE)、LDDSE결합 IBS검사。관심병조(CAD조)22례,경QCA학진위관심병,병행경피관맥개입술(PCI),술전1주내행 LDDSE[5μg/(kg· min)、10μg/(kg· min)]검사、정식급초산감유(NTG)개입99m Tc 갑양기이정기이정단광자발사계산궤단층관주현상(SPECT)검사,우정식、DSE매급부하5 min채집전심첨절면(장축、이강、사강)IBS도상,술후3개월복사이유초성。탐색재 LDDSE과정중,이 CVIB최대변화치(K)>0.7정의위존활심기,검측기식별존활심기적준학성,병여 LDDSE、SPECT진행비교。결과여 LDDSE상비,LDDSE결합 IBS기술검측존활심기민감성、준학성명현제고(91.1% vs 77.8%；90.4% vs 75.7%,P<0.05)；여 SPECT상비민감성、준학성균명현제고(91.1% vs 80.0%；90.4% vs 76.5%,P<0.05)。결론 LDDSE결합 IBS기술검측존활심기준학성교 SPECT고,구유림상응용개치。
Objective To explore the clinical value of low dose dobutamine(Dob)stress echocardiography(DSE)combined with inte-grated backscatter(IBS)for identifying viable myocardium in patients with coronary artery disease(CAD).Methods Eighteen pa-tients whose results of the quantitative coronary artery were normal underwent the examination of 2 DE,DSE with IBS in group CON.22 patients who were diagnosed CAD by quantitative coronary artery (QCA)in group CAD,percutaneous coronary intervention (PCI)was performed further LDDSE [5,10μg/(kg· min)]and rest/NTG SPECT were checked one week before PCI.IBS images at rest and every grade infusion of Dob 5 minutes were obtained in total apical views(Lax,2 ch,4 ch).Two dimension echocardio-graphy was examined after three months of PCI again.Defining the maximum changing value of CVIB (K)during DSE>0.7 as viable myocardium,then the accuracy in identifying viable myocardium were compared among LDDSE,SPECT and LDDSE combined with IBS.Results The sensitivity,accuracy for identifying viable myocardium were significantly higher by LDDSE combined with IBS than those of LDDSE (sensitivity:91.1% vs 77.8%,accuracy:90.4 vs 75.7%,respectively P<0.05).Compared with SPECT,the sensitivi-ty and accuracy had been significantly improved by LDDSE combined with IBS,whose numbers were 91.1%,90.4% respectively. Conclusion LDDSE combined with IBS identifying viable myocardium has higher accuracy than SPECT,it is more practical in clinic.