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目的评价定量实时心肌声学造影(RT-MCE)联合小剂量多巴酚丁胺负荷超声心动图(LD-DSE)检测存活心肌的临床价值。方法22例经彩色超声检查存在左心室壁节段运动障碍的冠心病患者,进行RT-MCE、RT-MCE联合LD-DSE、冠状动脉造影(CAG)及介入治疗(PCI),所有狭窄病变均行完全血运重建。RT-MCE图像按美国心脏超声协会16节段划分法获得各运动异常节段心肌灌注显影,用QLab软件定量分析法求出各节段的β值及A.β值。术后1、3、6个月时分别复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果普通RT-MCE各节段A值以3.78、β值以0.38和A.β值以1.39为截断点,诊断存活心肌的灵敏度、特异度及准确度分别是70.2%、68.5%、70.2%和87.4%、78.9%、83.1%及80.6%、89.5%、83.8%;联合LD-DSE后,各节段A值以3.84、β值以0.49和A.β值以1.74为截断点,诊断存活心肌的灵敏度、特异度及准确度分别是72.4%、67.8%、71.2%和87.4%、89.5%、88.1%及90.3%、82.5%、86.2%。联合LD-DSE后,RT-MCEβ值定量法检测存活心肌的特异度和A.β值定量法检测存活心肌的灵敏度均有明显提高(89.5%vs78.9%;90.3%vs80.6%,P值均<0.05)。结论RT-MCEβ值及A.β值定量分析法检测存活心肌有较高的临床价值,联合小剂量多巴酚丁胺负荷可提高其检测价值。
Objective To evaluate the clinical value of quantitative real-time myocardial contrast echocardiography (RT-MCE) combined with low-dose dobutamine stress echocardiography (LD-DSE) in detecting viable myocardium. Methods Twenty-two patients with coronary artery disease with left ventricular wall motion disorder were examined by color sonography. RT-MCE, RT-MCE combined with LD-DSE, coronary angiography (CAG) and interventional therapy (PCI) Complete revascularization. RT-MCE images were obtained according to the 16th segment method of American Society of Aesthetic Diseases myocardial perfusion and imaging in each segment of abnormal motion. The β value and A.beta value of each segment were calculated by quantitative QLab software. Cardiac echocardiography was retrospectively performed at 1, 3, and 6 months after surgery. The improvement of systolic function of the ventricular wall after coronary revascularization was the gold standard for determining viable myocardium. Results The sensitivity, specificity and accuracy of the common RT-MCE segments were 70.2%, 68.5%, 70.2% and 3.78 respectively for the diagnosis of viable myocardium with 3.78, β values of 0.38 and A.β values of 1.39 as cut-off points 87.4%, 78.9%, 83.1% and 80.6%, 89.5% and 83.8% respectively. After combining LD-DSE, the value of A in each segment was 3.84, the value of β was 0.49 and the value of A.β was 1.74. The sensitivity, specificity and accuracy were 72.4%, 67.8%, 71.2% and 87.4%, 89.5%, 88.1% and 90.3%, 82.5% and 86.2%, respectively. After combined with LD-DSE, the specificity of viable myocardium by RT-MCEβ quantitative assay and the sensitivity of A.beta value determination of viable myocardium were significantly increased (89.5% vs78.9%, 90.3% vs80.6%, P All <0.05). Conclusion RT-MCEβ and A.β quantitative analysis of viable myocardium has a higher clinical value, combined with low-dose dobutamine load can increase its detection value.