选择性心肌超声造影联合定量组织多普勒评价冠状动脉介入治疗改善心肌灌注及心肌功能的初步研究

Primary study on the myocardium perfusion and function improvement after percutaneous coronary intervention using selective myocardium contrast echocardiography combined with quantitative tissue Doppler imaging

目的应用选择性心肌超声造影(MCE)及定量组织多普勒对冠状动脉介入治疗(PCI)后病变心肌灌注及收缩功能变化进行研究。方法20例行PCI的患者,于PCI前后经冠状动脉内注入造影剂SonoVue,应用MCE观察心肌显影效果、造影剂显影途径,定量分析心肌灌注情况;应用定量组织多普勒测量病变心肌收缩功能变化。结果注入造影剂后心肌清晰显影,患者术前MCE造影剂充盈情况与冠状动脉造影证实病变区域一致,冠状动脉成功开通患者术后即刻MCE显示缺血节段充盈较术前显著改善;6例患者观察到少量造影剂经心肌直接漏入左室腔;定量组织多普勒提示冠状动脉成功开通的患者病变心肌运动位移、应变改善。结论选择性MCE能满意显示心肌灌注状态,并能观察到缺血心肌局部微循环与心室腔直接相通;PCI即刻可以改善心肌局部微循环及局部心肌功能。

Objective To explore the myocardium perfusion and systolic function improvement post percutaneous coronary intervention（PCI） by using selective myocardium contrast echocardiography（MCE） combined with tissue Doppler imaging（TDI） in 20 patients undergone PCI. Methods SonoVue was injected into coronary artery before and after PCI, and MCE was applied to observe the perfusion change of ischemic myocardium with quantified software. Myocardium systolic function was evaluated with TDI. Results Clear images of myocardium could be acquired after contrast injection and MCE demonstrations were identical to coronary angiogram results. Myocardium perfusion was increased after intervention in successful cases, six of them with contrast leakage into left ventricle cavity from myocardium. TDI indicated ischemic myocardium displacement and strain improved after PCI. Conclusions MCE can reveal the perfusion status of myocardium and verify the endomural collateral existence in the ischemic myocardium. PCI therapy can improve the myocardium microcirculation regional ischemic myocardium function.