腺苷负荷下应变及应变率成像评价心肌存活性的临床研究

Evaluation of myocardial viability by strain and strain rate imaging under adenosine stress

目的探讨应变及应变率成像结合腺苷负荷超声心动图评价心肌存活性的临床价值。方法采用应变及应变率成像检测27例心肌梗死患者静息状态和腺苷负荷状态下各节段全心动周期最大应变(εmax)、射血期峰值应变(εet)及心肌收缩期峰值应变率(Rpeaksys),以核素心肌灌注/代谢显像结果作为金标准将心肌各节段划分为存活组及非存活组。结果静息状态下存活组与非存活组心肌间各指标比较,差异无统计学意义(P>0.05);腺苷负荷状态下,存活组心肌εet、SRpeaksys较静息状态明显增加,差异有统计学意义(P<0.05,P<0.01);非存活组心肌εmax、εet、SRpeaksys与静息状态下比较,差异无统计学意义(P>0.05)。结论应变及应变率成像技术结合腺苷负荷超声心动图能够区别存活与非存活心肌。

Objective To explore the clinical value of strain imaging （SI） and strain rate imaging （SRI） under adenosine stress in evaluating myocardial viability. Methods SI and SRI were performed on 27 patients with myocardial infarction, the maximum strain during the entire heart （ εmax ）, strain during ejection time （ εet ）, and peak systolic strain rate （SRpeak sys ） were measured. Radionuclide myocardial perfusion / metabolic imaging was served as the ＂gold standard＂ to define the viable and nonviable myocardium. Results There was no significant difference of myocardial parameters between viable and nonviable myoeardium at rest condition （ P 〉 0.05 ）. At adenosine stress condition, εet and SRpeak sys in viable myocardium were increased than those at rest condition, there was significant difference （ P 〈 0.05, P 〈 0.01 ）, while there was no significant difference of εet and SRpeak sys between stress and rest condition in nonviable myocardium. Conclusion SI and SRI combined with adenosine stress echocardiography can identify viable and nonviable myocardium.