小剂量多巴酚丁胺负荷试验结合心肌背向散射积分与多普勒组织成像检测存活心肌的临床研究

Comparison study of echocardiography with or without low dose dobutamine stress combined with integrated backscatter and Doppler tissue image for identifying survival myocardium in patients with coronary artery disease

目的：探讨小剂量多巴酚丁胺负荷超声（LDDSE）结合心肌背向散射积分（IBS）与负荷多普勒组织成像（DTI）检测存活心肌的准确性.方法：20例经冠状动脉定量造影术（QCA）确诊为冠心病患者行经皮冠状动脉介入治疗术（PCI）.术前1周内行LDDSE检查及采集IBS、DTI图像,术后（3月）复查二维超声.探索在LDDSE过程中,以IBS参数背向散射积分变异幅度（CVIB）最大变化率（K）＞13定义为存活心肌,检测其识别存活心肌的准确性.以负荷下DTI最大Vs与静息时Vs的差值（T）＞2.0cm/s定为存活心肌,检测其识别存活心肌的准确性.结果：LDDSE结合DTI或IBS技术检测存活心肌敏感性、特异性、准确性明显提高（P＜0.05～0.01）;LDDSE结合DTI较LDDSE结合IBS技术诊断存活心肌的敏感性、准确性降低（依次为78.9%,79.1%Vs 86.7%,87.1%）（P＜0.05）,尽管LDDSE结合DTI诊断存活心肌的特异性（81.25%）较LDDSE结合IBS（87.5%）降低,但差异无显著性意义.结论：LDDSE结合IBS较LDDSE结合DTI评估存活心肌灵敏性稍高.

Objective： To compare the accuracy of low dose dobutamine （Dob） stress echocardiography （LDDSE） combined with integrated backscatter （IBS） and that combined with Doppler tissue image （DTI） for identifying survival myoeardium in patients with coronary artery disease（CAD） .Methods：Percutaneons coronary intervention（PCI） was performed in 18 patients for CAD by quantitative coronary artery（QCA）. LDDSE was applied and images and parameters IBS or DTI were obtained before a week of PCI. Two-dimensional echocardiography was panfomed after three months of PCI again. Defining the maximumal changing rote of CVIB（K） of IBS （during LDDSE 〉 13） and the maximumal change of Vs（K） of （DTI during LDDSE 〉 2cm/s） were defined as survival myocardium and then the accuracies in identifying survival myocardium were compared among LDDSE. IBS combined with LDDSE, and DTI combined with LDDSE.Resuits：The sensitivity, specificity, accuracy for identifying survival myoeardium by LDDSE combined with IBS and DTI were significantly higher than those of LDDSE [5, 10μg/（Kg.min）] （ P 4 〈 0.05 ～ 0.01 ）, as well as compared with DTI, the sensitivity, accuracy were 86.7% ,87.1% Vs 78.9% ,79.1% and significantly improved respectively by LDDSE ＋ IBS （ P 〈 0.05）. The specificity of LDDSE combined with DTI was than that of LDDSE combined with IBS（ 87.5% Vs 81.3% ）（ P 〈 0.05） .Conclusion：Identifying survival myocardium by LDDSE combined with IBS have a higher value than those of LDDSE combined with DTI alone.