用心肌声学造影评价择期经皮冠状动脉介入治疗改善心肌梗死患者心肌组织灌注的效果

Clincial assessment on myocardium perfusion of myocardial infarction after selective PCI using MCE techniques

目的应用选择性心肌声学造影（MCE）评价择期经皮冠状动脉（冠脉）介入治疗（PCI）改善心肌梗死患者心肌组织灌注的临床疗效。方法选择24例前壁心肌梗死患者，发病到择期PCI的时间为6±2（3—12）周，于PCI前选择性冠脉内注射声诺维（Sonovue），利用对比脉冲序列成像技术（CPS）进行心肌声学造影（MCE）检查；冠脉开通后30min再次行MCE检查，采用cuso软件进行脱机图像分析，计算心肌微血管血流量、最大造影剂充盈缺损面积和缺血心肌改善指数，评价心肌组织灌注效果。随访患者心脏功能及PCI术后30d的主要心脏事件（MACE）。结果（1）24例患者的“罪犯”血管完全开通，TIMI血流3级；（2）冠脉内注入造影剂即刻能够获得清晰心肌显影，所有患者均获得较满意左心室及心肌显影效果。MCE显示，24例于PCI术前“罪犯”左前降支血管对应心脏节段节段性充盈减低或无造影剂充盈，PCI术后30min92％（22／24）的患者心脏节段充盈较术前显著改善，局部血流量值较术前提高；（3）24例患者PCI术后72h左心室射血分数（EF值）较术前增加（52％±10％比62％±6％，P〈0．05），住院期间无MACE发生。本研究中2例PCI术后心肌灌注不良患者，分别于术后1个月出现心力衰竭（心功能Ⅲ级），1例术后2周出现劳累性心绞痛，均经药物治疗稳定。结论选择性MCE技术是一项简便、安全的评价冠脉介入术心肌组织灌注的有效方法；未行再灌注治疗的心肌梗死患者应尽早行择期PCI术，挽救梗死区的缺血心肌，改善左心室功能。

Objective To evaluate the myocardium perfusion of myocardium infarct area using myocardium contrast eehocardiography （MCE） techniques after selective PCI. Methods Twenty four patients with anterior MI history of 3 - 12 weeks were enrolled. Contrast pulse sequencing （CPS） MCE with Sonovue contrast via coronary route was done before PCI and 30 minutes later after PCI. Microvascular blood flow and maximum filled- blank area and meliorate rate of ischemic myocardium were calculated with the CUSQ off-line software. Heart function and cardiac events were followed-up within 30 days. Results （ 1 ） Complete reperfusion and TIMI grade Ⅲ flow was achieved in all the IRA in 24 patients. Clear images of myocardium could be acquired immediately after coronary angiography; （2） Contrast imagings of left ventricular and myocardium were well displayed in all patients. No perfusion or decreased perfusion in the segments of culprit occlusive coronary were showed in 24 patients before PCI. Good perfusion was revealled in 22 patients in the segments of criminal occlusive coronary and increasing local microvascular blood flow following PCI; （3） No MACE was found during in-hospital or the follow up period. Two patients showed ill perfusion in the segments of criminal occlusive coronary. One of them developed heart failure （grade Ⅲ ） and the other one had recurrent angina pectoris within 30 days. Conclusion CPS MCE is safe and feasible to reveal the peffusion status of myocardium. Selective PCI therapy can enhance the left ventricular function by improving microcirculation of ischemic myocardium in myocardial infarction patients without reperfusion therapy before.