心肌声学造影对冠状动脉血运重建术心肌灌注的评价研究

The effects of myocardial contrast echocardiography in myocardial perfusion testing after coronary revascularization

目的探讨心肌声学造影(MCE)评估缺血心肌血运重建后心肌灌注的价值。方法 36例缺血性心肌病患者分别予以冠状动脉支架置入术或冠状动脉旁路移植术进行血运重建,在术前、术后早期(<1个月)、及术后晚期(6～12)个月分别行实时MCE检查,根据造影剂的充盈程度进行评分。将其结果与相应阶段造影(CAG)和(或)冠脉增强CT成像(CTA)结果进行对照分析。结果按16段心肌节段法进行分段分析测量。36例患者576个节段中,运动异常节段247个,MCE结果与治疗前冠脉造影吻合率为89.89%。冠脉血管再通术后早期共有172个节段有改善,与冠状动脉支架置入术或冠状动脉旁路移植术靶血管供血支配区吻合率为78.00%。术后晚期,MCE与冠脉影像结果吻合率为80.56%。结论实时MCE可随访观察冠状动脉再通血运重建缺血心肌血流灌注改善的情况,可尝试用于冠心病血管重建术后的临床随访。

Objective To investigate the significance of myocardial contrast echocardiography（MCE） during follow-up period after coronary revascularization in the patients with ischemic cardiomyopathy.Methods The patients（n=36） were respectively given intracoronary stent implantation or coronary artery bypass grafting（CABG） for coronary revascularization,and then their were given real-time MCE and graded according to the filling degree of contrast before coronary revascularization,and at early stage（one month） and late stage（6-12 months） after coronary revascularization.All results were compared and analyzed with the results of coronary angiography（CAG） and/or coronary enhanced CT angiography（CTA） in corresponding stages.Results The detection and analysis were conducted according to 16-segment myocardial segment method（recommended by American Society of Echocardiography）.Among 576 segments in 36 patients,there were 247 dysfunctional segments.The matching rate between MCE and CAG before treatment was 89.9%.There were 172 segments improved at the early stage after coronary revascularization,and the matching rate between MCE and blood-supply area of stent or CABG target vessels was 78.6%.At the late stage after coronary revascularization,the matching rate between MCE and CAG reduced to 80.56%.Conclusion Real-time MCE can be used for following and observing the improvement of myocardial perfusion in clinical follow-up after coronary revascularization.