小剂量多巴酚丁胺负荷超声心动图试验rn对可逆性功能障碍心肌预测的新指标

摘要

目的探讨小剂量多巴酚丁胺负荷超声心动图（DSE）试验中左心室功能EF值的变化，即ΔEF这一量化指标预测急性心肌梗死（AMI）后患者的功能障碍心肌是否可逆及其可恢复程度。方法入选患者25例，均接受小剂量DSE检查，测定负荷试验各阶段的收缩功能EF值。25例患者亦接受冠脉造影，并择期行经皮经腔冠状动脉成形术(PTCA)治疗，根据病变血管的情况植入支架。在术后 3.5～13个月之间复查小剂量DSE试验。结果以小剂量DSE 过程中EF增加值，即ΔEF≥15%作为衡量标准，预测可逆性功能障碍心肌的敏感性、特异性和准确性分别为 70.6%、75%和72%，此预测改善值与无改善值之间的差异有显著性意义(P<0.05)。结论ΔEF可以作为准确评价可逆性功能障碍心肌的指标，并且是一种定量测定方法。%Objective　The accurate recognition of reversible myocardial dysfunction may allow a more rational recommendation for coronary revascularization. The low-dose dobutamine stress echocardiography have been proposed for the defection of myocardial viability.The alteration of EF(ΔEF) during low-dose DSE was used to be a target to judge the reversible myocardial dysfunction.Methods　In the patients with definite acute myocardial infarction, low-dose DSE was performed before and after elective coronary angioplasty. The left ventricular systolic function was evaluated according to the Simpson′s rule before and during dobutamine infusion ( 5 and 10 μg*kg-1*min-1). Results　The sensitivity, specificity and accuracy for determining the predictive values of pre-angioplasty DSE on regional recovery reached 70.6%,75% and 72%,respectively.Conclusions　The alteration of EF (ΔEF) can be considered to be a standard to judge whether the myocardial dysfunction is reversible or not.