小剂量多巴酚丁胺负荷下超声斑点追踪技术与磁共振延迟增强显像技术评价陈旧性心肌梗死存活性研究

摘要

目的:比较磁共振延迟增强显像(DE-MRI)技术与小剂量多巴酚丁胺负荷斑点追踪超声(LDDS-STE)技术评价陈旧性心肌梗死患者存活心肌方面的敏感性和特异性.方法:选取30例本院住院陈旧性心肌梗死患者为研究对象.上述患者接受经皮冠状动脉介入治疗(PCI)术前进行心脏核磁共振检查及超声心动图检查,LDDS-STE方法分析静息和负荷条件下左心室室壁运动异常节段短轴径向应变(RS)及应变率(RSr),术后1,3,6个月复查超声心动图,观察室壁运动反常节段运动是否改善或恢复,以室壁运动分数改善作为判断存活心肌的金标准.结果:30例患者共获得510个左心室可分析节段,超声心动图判定室壁运动异常节段201个.与金标准比较,静息状态下左心室径向应变(RSrest)预测陈旧性心肌梗死患者存活心肌受试者工作特征(ROC)曲线下面积为0.636,敏感性为60.0%,特异性为60.5%;小剂量多巴酚丁胺负荷条件下左心室径向应变(RSLDDS)预测存活心肌ROC曲线下面积0.806,敏感性和特异性分别为79.1%及82.7%.静息状态下左心室径向应变率(RSrrest)预测陈旧性心肌梗死患者存活心肌敏感性为60.0%,特异性为60.5%,ROC曲线下面积0.646;小剂量多巴酚丁胺负荷条件下左心室径向应变率(RSrLDDS)预测存活心肌敏感性和特异性较静息状态下明显提高,分别为80.0%及83.7%,ROC曲线下面积0.808.DE-MRI技术预测存活心肌的敏感性和特异性分别为90.8%和87.1%,准确性89.5%,ROC曲线下面积为0.901.结论:DE-MRI与LDDS-STE方法均能准确识别梗死后存活心肌,但DE-MRI方法检测存活心肌的价值稍高于LDDS-STE,且准确率及重复性高,耗时短,为临床预测陈旧性心肌梗死患者PCI术的疗效及治疗策略的选择提供重要依据.%Objective: To compare the sensitivity and specificity between low dose dobutamine stress speckling tracking echocardiography (LDDS-STE) and delayed enhancement MRI (DE-MRI) for assessing viable myocardium (VM) in patients with old myocardial infarction (OMI). Methods: A total of 30 in-hospitalized OMI patients were enrolled, all patients received cardiac MRI and LDDS-STE prior percutaneous coronary intervention (PCI). Radial peak systolic strain (RS) and strain rate (RSr) were analyzed by LDDS-STE at both resting and loading conditions, echocardiography was performed at 1, 3 and 6 months after PCI to observe the cardiac wall motion changes and the improvement of wall motion score was taken as golden standard of VM. Results: 510 left ventricular segments were obtained for analysis in 30 patients and echocardiography indicated 201 segments with abnormal wall motion. Compared with golden standard, the area under ROC curve of RSrest for detecting VM was 0.636 with the sensitivity at 60.0% , specificity at 60.5% and the area under ROC curve of RSLDDS for detecting VM was 0.806 with the sensitivity at 79.1%, specificity at 82.7%; the area under ROC curve of RSrrest for detecting VM was 0.646 with the sensitivity at 60.0% , specificity at 60.5% and the area under ROC curve of RSrLDDS for detecting VM was 0.808 with the sensitivity at 80.0%, specificity at 83.7% which were obviously improved than RSrrest . By DE-MRI, the area under ROC curve for detecting VM was 0.901 with the sensitivity at 90.8%, specificity at 87.1% and accuracy at 89.5%. Conclusion: Both DE-MRI and LDDS-STE can recognize VM in OMI patients; while DE-MRI had the better accuracy and repeatability, cost less time which may provide important basis for predicting the efficacy of PCI and for making the treatment strategy.