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目的应用组织追踪和彩色多普勒冠状动脉血流显像(CDCFI)结合多巴酚丁胺负荷试验分析不同时间的缺血再灌注对左室心肌收缩功能和冠状动脉血流的影响,以期为评估心肌存活性提供简便快捷的定量指标。方法健康杂种犬25条,随机分为顿抑组和梗死组。应用组织追踪和CDCFI技术观测顿抑组和梗死组缺血区(前间隔)于基础状态、再灌注30min以及再灌注90min多巴酚丁胺负荷前后二尖瓣环收缩期向心尖方向运动的最大位移(MVD)以及左前降支中远段舒张期冠状动脉血流储备(CFR)的动态变化。结果多巴酚丁胺负荷试验后,不同再灌注时间顿抑心肌和梗死心肌前间隔MVD的增加率(ΔD%)和左前降支的CFR值均明显低于基础状态(P<0.001,P<0.05),顿抑组的ΔD%以及CFR值均明显高于梗死心肌(P<0.001,P<0.05),并随再灌注时间延长,有逐渐好转趋势(P<0.05,P<0.05);而梗死心肌则无此变化趋势(P>0.05,P>0.05);CFR与二尖瓣环收缩期向心尖运动的最大位移变化率之间有良好的相关性(r=0.719,P<0.05)。结论结合组织追踪技术和CDCFI技术动态观察缺血再灌注心肌多巴酚丁胺负荷后心肌收缩功能和冠状动脉血流动力学变化,可以提高判断存活心肌的准确率。
Objective To evaluate the effects of ischemia-reperfusion on left ventricular systolic function and coronary blood flow with tissue tracking and color Doppler coronary flow imaging (CDCFI) combined with dobutamine stress test Evaluate myocardial viability to provide quick and easy quantitative metrics. Methods 25 healthy mongrel dogs were randomly divided into the control group and the infarction group. Using tissue tracking and CDCFI technique, we observed the maximal apical motion of mitral annulus before and after dobutamine stress at 30 min after reperfusion and 30 min after reperfusion (MVD) and the diastolic coronary flow reserve (CFR) in the mid-distal left anterior descending artery. Results After the dobutamine stress test, the increase rate of myocardial mitochondrial membrane potential (ΔD%) and the left anterior descending coronary artery (CFR) were significantly lower than those of baseline at different time of reperfusion (P <0.001, P < (P <0.05, P <0.05). The ΔD% and CFR values of the patients in the suppression group were significantly higher than those in the infarcted myocardium (P <0.001, P <0.05), and gradually improved with the reperfusion time (P> 0.05, P> 0.05). There was a good correlation between CFR and rate of change of maximal displacement of apical systolic to mitral annulus (r = 0.719, P <0.05). Conclusions The dynamic changes of myocardial systolic function and coronary hemodynamics after myocardial ischemia and reperfusion of dobutamine stress can be improved by using tissue tracking technique and CDCFI technique to improve the accuracy of determining viable myocardium.