组织多普勒判别方程法定量检测冠心病人存活心肌

Discriminant equation combined with tissue Doppler imaging to detect hibernating myocardium Quantitatively in patients with coronary artery disease

目的探讨DTI（多普勒组织显像技术）结合DSE（超声多巴酚丁胺负荷试验）建立判别方程定量检测存活心肌的可能性。方法37例研究对象，均按常规行定量冠状动脉造影（QCA）检查，其中25例确诊为冠心病（CAD），将25例CAD患者随机分为CAD1组15例和CAD2组10例，12例为QCA阴性的正常人作为对照组（CON组）；三组间年龄、性别、体重指数等均无统计学差异（P〉0．05）。其中CON组和CAD1组采用标准的DSE方案（0～40μg／kg·min），CAD2组采用标准DSE方案与异舒吉合用；使用DTI技术，分别于静息状态、小剂量（10μg／kg·min）及峰值剂量时观察左室16个节段心肌运动速度的变化，记录各室壁节段的收缩期（S）、舒张早期（E）及舒张晚期（A）的峰值速度V、加速时间AT、减速时间DT和时间速度积分VT1，以＆V≥35％为判定存活心肌的标准，建立判别方程。结果所建立的判别方程CON组错判CAD1和CAD2组的比例是16．67％；CAD1组错判CON组的比例为12．50％；CAD2组错判CON组的比例为11．11％。结论组织多普勒判别方程法可以精确定量地检测存活心肌，为DSE开辟了一务新途径。

Objective To evaluate the possibility of discriminant equation combined with DTI during DSE to detecting hibernating myocardium quantitatively in patients with coronary artery disease. Methods 37 patients were divided into 3 groups according to the results of Quantitative coronary angiography（QCA）, the control group（CON） including 12 patients, the coronary artery disease group 1 （CAD1） including 15 patients, and the coronary artery disease group 2（CAD2） including 10 patients. Among the three group, the standard DSE＋ Isoket was done in CAD2,while the standard DSE was done in the other two groups. The peak velocity（V）, ascending time（AT）, descending time（DT） and velocity- time index（VTI） of Doppler Tissue Imaging were gained in 16 segments of left ventricular of every patients, and≥35% was regarded as the standard detecting hibernating myocardium, and the discriminant equation was founded. Results According to the discriminant uquation, the incorrectly discriminant rate of CON was 16.67%, and the incorrectly discriminant rate of CAD1 was 12. 50 %, while 11. 11 was CAD2. Conclusions Discriminant equation combined with tissue Doppler imaging could detect hibernating myocardium quantitatively and accurately, which is a new road to DSE.