目的:探讨超声二维应变成像技术评价陈旧心肌梗死患者心肌存活的可行性.方法:72例准备接受血运重建术的陈旧心肌梗死患者,于术前1周行双核素心肌灌注与代谢扫描,以18F-FDG代谢显像在灌注减低节段内出现≥1分的改善视为存活心肌.同期应用二维应变成像技术检测左室短轴基底、中间及心尖各节段径向峰值应变(PRS)、圆周方向峰值应变(PCS),比较存活心肌组与非存活心肌组应变参数.结果:常规超声共检出运动异常节段258个,经同位素心肌灌注-代谢扫描诊断存活心肌节段数133个,坏死心肌节段数125个.对照组、存活心肌组的PRS和PCS 均明显高于坏死心肌组 (P ＜ 0.01);对照组与存活心肌组PCS无明显差异(P﹥0.05),对照组PRS明显高于显存活心肌组(P ＜ 0.01).以峰值RS≥18.32%、峰值CS≤-10.54%为截断值,预测存活心肌敏感性分别为73.8%、75.6%,特异性分别为89.3%、85.6%,ROC曲线下面积分别为0.84和0.79.结论:超声二维应变成像技术预测存活心肌是可行的,为定量评估心肌梗死后存活心肌性提供了一种新的方法.%Objective This study sought to evaluate viable myocardium in patients with myocardial infarction using speckle tracking echocardiography. Method In 72 patients with previous myocardial infarction, myocardial viability was assessed using dual-isotope imaging and speckle tracking imaging (STI). Segments were considered viable when low-perfused segments improved at least 1degree during 18F-FDG metabolism imaging. Radial strain (RS), circumferential strain (CS) of regional myocardium were measured on LV short axis mitral valve and apex views for each patient. Results Isotope myocardial perfusion-metabolic scan detected 133 viable segments and 125 necrosis segments. Viable segments'peak RS and peak CS were greater than those of necrosis segments; According to ROC curve, assuming peak RS ≥ 18.32％, peak CS ≤-10.54％ as the optimal cut-off for evaluating myocardial viability, the sensitivity were 73.8％ vs. 75.6％, specificity were 89.3％ vs. 85.6％, respectively. Area under the ROC curve (AUC) were 0.84 and 0.79, respectively. Conclusions Speckle tracking echocardiography is feasible in identificating viable myocardium, providing a novel method for quantitative assessing viable myocardium after myocardial infarction.
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