超声背向散射对急诊冠状动脉介入治疗后心肌存活性的检测

Ultrasonic integrated backscatter in detecting myocardial viability in patients treated with primary PCI

目的:探讨超声背向散射技术(IBS)对急性心肌梗死(AMI)行急诊经皮冠状动脉介入治疗术(PCI)后的患者识别存活心肌的临床应用价值。方法:应用IBS对13例首次AMI并行急诊PCI的患者在入院后第1、3、10天进行参数采集,并脱机进行分析,以3个月后室壁节段运动恢复者作为判断心肌存活的最终标准。结果:IBS在第3天时就可以较敏感地检测到存活心肌,较室壁运动的恢复提前。第3天和第10天检测存活心肌的敏感性、特异性、阳性预测值、阴性预测值分别为63.0%、73.7%、72.3%、58.3%;78.9%、78.9%、82.7%、65.2%。结论:IBS可以较早地检测AMI行急诊PCI的患者的存活心肌,并对功能恢复有较高的预测价值。

Objective：To evaluate the diagnostic accuracy of ultrasonic integrated backscatter in detecting myocardial viability in patients with reperfused acute myocardial infarction. Method Integrated backscatter images were obtained in thirteen patients with a first AMI successfully treated with primary PCI （TIMI Ⅱ ～ Ⅲ ） on day 1,3, and 10 after admission. Resting echocardiography was performed at day 1 and 3 months to evaluate the effective recovery of regional wall motion. Result： With integrated backscatter images, viable myocardium was detected in day 3 and day 10 with a sensitivity, specificity, positive predictive value and negative predictive value of 63.0%, 73.7%,72.3%,58.3%;78.9%,78.9% ,82.7% and 65.2% ,respectively; and wall motion improvement was preceded by cyclic variation of intergrated back scatter normalization. Conclusion： IBS can detect viable myocardium before wall motion improvement and can predict the recovery of dysfunctional myocardium early in reperfused acute myocardial infarction.