低剂量多巴酚丁胺负荷超声心动图预测初发急性心肌梗死后心室壁运动障碍的改善

Prediction of Improvement of Regional Wall Motion After First Acute Myocardial Infarction Using Low Dose Dobutamine Stress Echocardiography

目的：探讨低剂量多巴酚丁胺负荷超声心动图（ＬＤＤＳＥ）和９９ｍ锝甲氧基异丁基异腈（９９ｍＴｃＭＩＢＩ）心肌显像对初发急性心肌梗死患者心室壁运动障碍自发性改善的预测价值。方法：２７例初发急性心肌梗死患者于发病后１周内行ＬＤＤＳＥ试验，并随访４个月后的心室壁运动。９例溶栓治疗患者行９９ｍＴｃＭＩＢＩ心肌显像。结果：９例溶栓治疗患者中，６例发生缺血再灌注，随访时心室壁运动障碍改善。未发生缺血再灌注的３例患者中，２例随访时心室壁运动障碍改善，１例恶化。ＬＤＤＳＥ试验对急性心肌梗死后心室壁运动障碍自发性改善预测的敏感性、特异性分别为７１％和８４％，阳性预测值和阴性预测值均为７８％。

Objective:To evaluate the role of low dose dobutamine stress echocardiogrphy (LDDSE) test and technetium 99m sestamibi( 99m Tc MIBI) myocardial scintigraphy in the prediction of spontaneous improvement of regional wall motion in patients with acute myocardial infarction(AMI). Methods:The regional wall motion of 27 patients with a first AMI(thrombolysis in 9 cases) was evaluated with 2 dimentional echocardiography and LDDSE test within 1 week after the onset of chest pain and in later follow up.In 9 thrombolytic cases myocardial scintigraphy was performed with 99m Tc MIBI before and within 1 week after thrombolysis. Results:The LDDSE test showed 6 cases who had patency of infarct related artery among 9 subjects undergone thrombolytic theraphy with an improved regional wall motion;3 cases failed in thrombolytic therapy.The regional wall motion was improved in 2 cases but worsened in 1 of the 3 failed cases.The sensitivity,specificity,positive and negative predictive values of LDDSE test for predicting late recovery of regional function were 71%,84%,78%and 78%,respectively. Conclusion:LDDSE test has higher predictive value for spontaneous improvement of regional wall motion in subjects with a first AMI.