采用定性定量经冠脉超声心肌声学造影对非闭塞性病变心肌灌注水平的探讨

Qualitative and quantitative intracoronary myocardial contrast echocardiography in detecting myocardial perfusion level in patients with coronary artery disease with coronary artery partial occlusion

目的探讨经冠状动脉超声心肌声学造影(myocardial contrast echocardiography,MCE)评价非完全闭塞性冠状动脉的狭窄程度与心肌灌注水平二者关系时,定性与定量分析方法的特点。方法35例住院患者行选择性冠状动脉造影,检测冠状动脉病变程度;经冠状动脉注射造影剂行实时MCE,采用记分的方式对结果进行视觉定性分析,并由定量分析得到以下参数造影剂峰值密度(A)、曲线下面积(area under the curve,AUC)、峰值时间(time to peak intensity,TP);利用统计学方法对相应心肌节段的组织灌注情况进行分析。结果35例患者冠状动脉造影正常6例(17%),其余29例(83%)至少有1支血管狭窄≥50%;MCE检测210个心肌节段中有167个(79.6%)获得较满意图像,定性分析从中发现异常心肌灌注节段17个(12.2%),均来自病变组;而定量分析显示,与正常组比较,轻度狭窄组无明显变化,中度狭窄组AUC明显降低(P<0.05),重度狭窄组A、AUC和TP值均产生显著变化(P<0.05)。结论MCE定性分析能直观检测病变血管所对应心肌的异常灌注状况,而定量分析能更好的反映病变血管与心肌灌注水平的关系。

Objective To investigate the different characteristics of qualitative and quantitative intracoronary myocardial contrast echocardiography （ MCE ） in evaluation of myocardial perfusion level in patients of coronary artery disease with coronary artery partial occlusion. Methods A total of 35 patients underwent selective coronary angiography, and then were intracoronarily injected with reagent SonoVue to perform MCE. Qualitative analysis was taken by visual valuing images with score on the segmental myocardial perfusion situation. Then contrast peak intensity （A）, time to peak intensity （TP） and area under the curve （AUC） were quantitated with time-intensity curve obtained by equipment attached software. Results The results of angiography showed that, out of 35 patients, the coronary artery stenosis of 6 patients were normal （ 〈 50% ） , and that of 29 patients were abnormal （≥50% ）. MCE produced a total of 210 corresponding myocardial perfusion images. Among them, 167 （79.6%） images were of good quality. The qualitative analysis detected 17 （12.2%） abnormal myocardial perfusion segments. Quantitative analysis results showed that, compared to normal group, the 3 myocardial perfusion parameters did not show significant change in mild abnormal stenosis group, whereas the AUC value markedly decreased （ P 〈 0.05 ） in moderate group, and all 3 parameters significantly changed in severe group （P 〈 0.05）. Conclusion Qualitative analysis shows potential in direct visual determination of abnormal myocardial perfusion. Quantitative analysis properly reflects the relationship between stenosis magnitude and abnormality of myocardial perfusion with a relatively high efficiency.