应用心肌声学造影评价冠状动脉血运重建术心肌灌注

摘要

目的 心肌声学造影(MCE)观察缺血性心肌病患者冠状动脉支架置入或冠脉搭桥后心肌血流灌注变化,探讨其在评估缺血性心肌血运重建后随访中的价值.方法 36例心肌声学造影患者,单支病变5例,2支病变(狭窄＞75％)19例,3支病变12例.36例患者分别予以介入支架植入术或冠脉搭桥术进行血运重建,术前、术后及随访6～12个月分别行实时心肌声学造影检查,根据造影剂的充盈程度进行评分.将其结果与相应阶段造影和/或冠脉增强CT成像(CTA)结果进行对照分析.结果 按左室壁16节段法进行分段.36例患者576个节段中,运动异常节段247个.与治疗前冠脉造影吻合率89.9％.冠脉血管再通术后1个月内复查172个节段有运动改善,与支架或搭桥靶血管供血支配区吻合率78.6％.血运重建术后自身对照灌注明显改善.在随访6～12个月间,心肌声学造影与冠脉影像结果吻合率降低为80.56％.其中造影或CTA显示血运正常而MCG示心肌灌注差者4例,其中有3例有糖尿病,4例患者心功能均低下；而靶血管再狭窄或闭塞,心肌灌注改善者3例,均为多支冠脉搭桥患者,前降支正常,回旋闭塞1支,另2例除前降支血管其他血管均闭塞.结论 实时心肌超声造影可随访观察冠状动脉再通血运重建缺血心肌血流灌注改善的情况,可尝试用于冠心病血管重建术后的临床随访.%Objective Myocardial contrast echocardiography (MCE) is used for assessing myocardial perfusion that allows for noninvasive quantification of regional myocardial blood flow (MBF). The value of MCE for MBF analysis is researched for the patients with ischemic heart disease who underwent coronary artery revascularization by CABG or Stent,especially in follow-up. Methods 36 patients with myocardial acoustic imaging patients, single lesion in 5 patients, and two lesions (narrow >75%) 19 cases, 3 branch of lesions in 12 cases. Before and 1 months, 6 — 12 months after revascularization, MCE was performed using continuous intravenous infusion of commercially available contrast agent with low mechanical index power modulation imaging. According to the related segments, the data were compared to the CAT and/or CAG. Results We measures left ventricular according to 16 segments. Totally, we get 576 scores about every segment from 36 patients. Regional mobile function recovery was observed, especially 247 dysfunctional segment. The myocardial viability in the zone dysfunctional zone were analysised with related supply artery. Coincidence rate was 89.9%, 78.6%, 80.56% at pre-operation, ealy post-operation, follow-up 6 ~ 12 months, respectively. We found MCE were more near to the clinical cardial function. It seemed to be related with DM, the number of stent or bypass graft, target artery re-stenosis. Conclusions MCE is a rapid, simple and safe technique and provide easy way for predicting regional function recovery after revascularization.