声学造影实时三维超声心动图对冠心病的诊断价值

Diagnostic value of contrast enhanced real-time three-dimensional echocardiography for coronary heart disease

目的评价声学造影实时三维超声心动图(CE-RT3DE)在冠心病诊断中的应用及其价值。方法收集2012年2月至2014年4月住院拟诊为冠心病的患者120例,均于经皮选择性冠状动脉造影术(CAG)前行CERT3DE定量分析。步骤为先经正中静脉缓慢推注声学造影剂声诺维(Sono Vue),行心肌声学造影(MCE),并结合CE-RT3DE图像获取整体心肌造影三维资料数据库,再联机或脱机对数据库进行分析处理做出诊断。然后进行CAG检查,对比分析CE-RT3DE与CAG的结果。结果以CAG诊断为金标准,CE-RT3DE诊断冠心病的敏感性为95.88%(93/97),特异性为95.65%(22/23),阳性预测值98.94%(93/94),阴性预测值56.52%(26/46),准确性为95.83%(115/120)。CE-RT3DE对冠状动脉病变≥2支(2支+3支)诊断的敏感性大于单支病变(100.0%vs88.24%,P<0.05)。结论 CE-RT3DE诊断冠心病敏感性、特异性及准确性高,无创,安全性高。

Objective To assess the applied value of contrast enhanced real-time three-dimensional eehoeardioglaphy （CE-RT31）E） for the diagnosis of coronary heart disease. Methods A total of 120 patients with tentative diagnosis of coro- nary heart disease admitted in our hospital between February 2012 and April 2014 were enrolled in this study. The CE- RT3 DE quantitative analysis was conduced before coronary angiography （CAG） in all patients. The steps were as follows：at first,the acoustic contrast agent （SonoVue） was slowly injected through the median eubital vein fi）r processing myocardial contrast eehoeardiography（MCE） ;then the three-dimensional data database of overall myoeardium was acquired in combi- ning with real-time three-dimensional eehocardiography; finally, the analysis was conducted by on-line or off-line to make the diagnosis. The results of CE-RT3DE and CA（, were compared. Results Based on CAG as the gold standard,the sensi- tivity ,specificity, positive predictive value, negative predictive value and accuracy for CE-RT3DE in diagnosis of coronary hear! disease were 95.88% （93/97）,95.65% （22/23）,98.94% （93/94）,56.52% （26/46）,and 95. 83% （115/ 120）,respectively. The sensitivily of CE-RT3DE in three branch plus double branch coronary arterial lesions was higher than that in single branch lesion （ 100.0% vs 88.24% ,P 〈 0.05）. Conclusions CE-RT3DE for the diagnosis of coronary heart disease have the advantages of high sensitivity,specificity ,accuracy,safety and noninvasive.