药物负荷三维超声心动图检测存活心肌的价值

摘要

目的:利用药物负荷三维超声心动图试验,检测心肌梗死患者的存活心肌.方法:50例心肌梗死患者行冠脉血液灌注重建术(PCI,CABG),在术前行三维超声心动图检查和多巴酚丁胺负荷超声试验,根据术后一个月复查心脏超声结果左室整体EF较术前改善＞5％与否分为存活心肌组(41例)和无存活心肌组(9例),三维超声检查时进行左室三维重建,将左心室分为17个节段,比较负荷试验前后左室整体射血分数(EF)及左室壁各节段的射血分数EF值.结果:术后1月多巴酚丁胺负荷三维超声试验:与负荷试验前比较,存活心肌组于负荷试验时左室整体EF值[(40±13)％比(53±15)％,P＜0.05],梗死区相关节段EF值[(33±12)％比(50±18)％,P＜0.01]均明显改善;无存活心肌组负荷试验前后左室整体EF值,梗死区相关节段EF值无明显改善(P均＞0.05).心梗患者于冠脉术后1月复查三维超声心动图,存活心肌组左室整体EF值术前、术后为(40±13)％,(49±15)％,改善20％,无存活心肌组EF值术前、术后为(36±8)％,(38±10)％,改善≤5％.结论:多巴酚丁胺负荷三维超声心动图检查对心肌梗死患者存活心肌的检测客观、可定量,有一定的临床应用价值.%Objective: To detect viable myocardium in patients with myocardial infarction (MI) by dobutamine stress three-dimensional echocardiography (DSE). Methods: After three-dimensional echocardiography and DSE, a total of 50 MI patients underwent coronary blood perfusion reconstruction (PCI, CABG). According to results of echocardiography with or without LVEF improvement >5% on one month after operation, they were divided into viable myocardium group (n = 41) and no viable myocardium group (n = 9). During three-dimensional echocardiography, left ventricular three-dimensional reconstruction was performed and left ventricle was divided into 17 segments. O-verall ejection fraction (EF) of left ventricle and EF of segments of left ventricular wall were compared between two groups before and after DSE. Results: Compared with before DSE, there were significant increase in overall EF of left ventricle [(40 ± 13)% vs. (53 ± 15)%, P<0.05] and EF of relative segments in infarcted area [(33 ± 12)% vs. (50± 18)%, P<0.01] on DSE in viable myocardium group on one month after operation; But those were not significant different in no viable myocardium group before and after DSE (P>0.05 both). Before and one month after operation overall EF of left ventricle were (40 ± 13)% and (49 ± 15)% respectively by three-dimensional echo-cardiography in viable myocardium group, which had improved by 20% ; but those were (36 ± 8)% and (38 ± 10)% before and after operation respectively in no viable myocardium group, which only improved ≤5%. Conclusion: Dobutamine stress three-dimensional echocardiography is objective and quantitative examination for detection of viable myocardium in patients with myocardial infarction and it possesses certain clinical application value.