经皮冠状动脉介入术后心肌灌注评价方法的比较

Comparing evaluative methods on myocardial reperfusion after percutaneous coronary intervention

目的 比较经冠状动脉超声心肌声学造影（MCE）与校正的心肌梗死溶栓临床试验（TIMI）帧数计数（CTFC）及冠状动脉血流速度方法对经皮冠状动脉介入术（PCI）后心肌灌注的评价,并探讨相关临床意义.方法 68例住院患者根据选择性冠状动脉造影结果,按血管狭窄程度分组：A组,正常对照组;B组,血管狭窄75%～95%;C组,血管狭窄＞95%;D组,急性血管闭塞.对各病变血管均进行PCI治疗,并恢复TIMI 3级血流.采用定量经冠状动脉MCE、CTFC及冠状动脉血流速度方法对术后心肌灌注状况进行检测.其中,经冠状动脉MCE有关定量参数分别为：造影剂峰值密度（A）反映心肌血容量;峰值时间（TP）反映心肌灌注速度;曲线下面积（AUC）反映心肌血流量.结果 PCI后心外膜血管恢复正常血流的前提下,各狭窄病变血管组CTFC与对照组差异无统计学意义;而闭塞血管组冠状动脉血流速度较对照组低;在MCE检测中,C组的心肌血容量及血流量较对照组低,而D组反映心肌灌注的3个参数值均较对照组差异均有统计学意义.结论 经冠状动脉MCE通过多个参数进行定量分析,较其他两种方法能更精确地评价PCI后心肌灌注状况.

Objective To investigate the capacity of different methods on evaluation of myocardial reperfusion after percutaneous coronary intervention, including quantitative inlracoronary myocardial contrast echocardiography （MCE）, corrected TIMI frame count and coronary artery blood flow velocity. Methods Sixtyeight patients were divided into four goups： A, normal coronary artery; B, coronary artery stenosis 75% - 95% ; C, coronary artery stenosis 〉 95% ; D, coronary acute total occluded, according to the results of selective coronary angiography. Myocardial reperfusion levels were evaluated using the different methods mentioned above at 15 min after PCI. The quantitative parameters of MCE involved contrast peak intensity （A）, time to peak intensity （TP） and area under the curve （AUC）, representing myocardial blood volume, reperfusion velocity and myocardial blood flow respectively. Results The CTFE was not different between the coronary artery stenosis groups and the normal group. Coronary artery blood flow was slower in group D than that in group A while myocardial blood volume and myocardial blood flow of MCE quantitative parameters markedly decreased in group C than those in group A, and three MCE parameters in D group were significant difference compared with group A. Condusion Quantitative intracoronary MCE was more accurate in the evaluation of myocardial repefusion than the other two methods.