实时心肌超声造影评价冠状动脉三支病变患者的心肌灌注

Assessment of myocardial perfusion in patients with triple vessel lesion of coronary artery using quantitative real-time myocardial contrast echocardiography

目的用实时心肌超声造影(real-timemyocardialcontrastechocardiography,RT-MCE)定量评价冠状动脉(冠脉)三支病变患者室壁运动和心肌血流灌注之间的关系。方法使用PhilipsSonos7500及S3探头,对32例经冠脉造影证实三支病变的患者经静脉给予SonoVue进行RT-MCE。将左室壁分为17节段,采用QLAB软件进行心肌灌注的定量分析。结果在异常冠脉供血区,有室壁运动异常节段的心肌血流量明显低于无室壁运动异常节段(1.86±1.09和10.82±5.54,P<0.01)。将血供异常但无室壁运动异常的心肌节段按供血冠脉的狭窄程度分为两组:供血冠脉狭窄程度≤70%组共50个节段,供血冠脉狭窄程度>70%组共135个节段。两组间的血管床横截面积(8.26±4.01和9.06±7.69,P>0.05)和心肌血流量值(11.20±10.5和9.07±11.01,P>0.05)差别无统计学意义,但后者的心肌局部血流速度值减低(1.45±0.38和1.05±0.21,P<0.05)。结论在冠脉三支血管病变中,无室壁运动异常区域的心肌血流速度与供血冠脉的狭窄程度有关。RT-MCE定量分析可用于评价冠脉三支病变患者的局部心肌灌注。

Objective To evaluate the relationship of the coronary angiogram, wall motion and myocardial blood flow （MBF） in patients with triple vessel lesion using quantitative intravenous real-time myocardial contrast echocardiography（RT-MCE）. Methods Thirty-two patients [27 men; mean age （57±6） years] with angioplasty testified triple vessel lesion were involved. RT-MCE was performed during intravenous administration of SonoVue using Philips Sonos 7500 with S3 probe. Myocardial perfusion was quantified offline using the QLAB advanced quantification software. Left ventricular myocardium was divided into 17 segments and 9 of them were used for analysis, which had high successful rate in the MCE. Plateau myocardial contrast intensity（A）, rate of rise（β） and MBF（Q = A ×β） were assessed. Results In segments with impaired vessel supply, MBF was significantly lower in segments with abnormal wall motion than segments with normal wall motion （ 1.86 ± 1.09 vs 10. 82 ± 5.54, P〈0. 01）. Segments with normal wall motion were divided into 2 groups. Group 1 had 50 segments, which had 70% or lower stenosis in the accommodated vessel. Group 2 had 134 segments with more than 70% stenosis in the relative vessel. There were no significant difference in A （8.26 ± 4.01 vs 9.06 ± 7.69, P 〉0. 05） and Q （11.20 ± 10.5 vs 9.07 ± 0.21, P 〉0.05） between group 1 and group 2, but β in group 2 was lower than that in group 1 （ 1.05 ± 0.21 vs 1.45 ± 0.38, P 〈0.05）. Conclusions RT-MCE can be used for quantitatively assessing myocardial perfusion in patients with triple vessel lesion of coronary artery.