选择性心肌超声造影对冠状动脉与左心室腔间侧支循环的观察与评价

Collateral circulation between myocardium and cardiac cavity assessed by selective myocardium contrast echocardiography

目的采用经冠状动脉选择性心肌超声造影(MCE)观察冠状动脉与左心室腔间侧支循环,并探讨其对于心肌缺血的意义。方法对26例冠心病患者及10例冠状动脉造影正常者的经冠状动脉内MCE进行回顾性分析,检出造影剂直接由心肌进入左心室腔的病例,测量局部节段灌注(minivalue),应用组织速度显像(TVI)测量相关节段收缩峰值速度(Sm)及与正常节段达峰时间差别(Ts-dif)。结果冠状动脉正常组未见冠状动脉与左心室腔间的侧支循环;冠心病组7例患者总计15个节段可见造影剂直接由心肌进入左心室腔,局部节段minivalue、Sm低于正常节段,但上述指标及Ts-dif优于缺血不伴侧支循环的节段。结论经冠状动脉选择性MCE能够清晰观察心肌内冠状动脉与心室腔间的侧支循环,此侧支循环可在一定程度上改善缺血心肌的收缩功能及心肌灌注。

Objective Myocardium ischemia could be alleviated by the collateral circulation, but little is known about the collateral circulation between myocardium and cardiac cavity. The aim of this study is to assess such collaterals as well as their potential effect on ischemic myocardium by selective myocardium contrast echocardiography （MCE） and tissue velocity imaging （TVI）. Methods A retrospective review was performed on 26 patients and 10 normal controls undergone selective intracoronary MCE. We assessed the presence of contrast leakage in cardiac cavity from myocardium directly and contrast path as well as sequence. The regional perfusion, peak systolic velocity （Sm） of the ischemic segments and the Vs time difference （Ts-dif） between ischemic segments and normal segments were measured with TVI. Results Contrast leakage was revealed in 15 segments in 7 patients by selective MCE. The perfusion, Sm and Ts-dif of segments with leakage were superior to the ischemic segments without leakage, but still lower than normal segments. No leakage was observed in normal controls. Conclusion The collateral circulation between myocardium coronary and cardiac cavity can be revealed by intracoronary MCE in patients with coronary artery disease, and the collateral ban improve regional systolic function as well as regional perfusion of ischemic segments.