左心腔声学造影在诊断冠心病伴室壁瘤中的应用价值

Clinical value of left ventricular opacification in the diagnosis of coronary heart disease with ventricular aneurysm

目的探讨常规经胸超声心动图(TTE)和左心腔声学造影(LVO)在诊断冠状动脉粥样硬化性心脏病(以下简称冠心病)伴室壁瘤中的应用价值。方法回顾性分析101例经冠状动脉造影证实为冠心病患者的TTE和LVO检查资料,比较两种检查方法对冠心病伴室壁瘤的检出率、大小及其超声图像特征。结果 101例冠心病患者中,TTE检出伴室壁瘤者12例(共12个),检出率为11.9%,其中心尖部7个,基底部宽度为(16.8±3.6)mm;其他部位5个,基底部宽度为(25.4±5.2)mm;LVO检出伴室壁瘤者43例(共48个),检出率为42.6%,其中心尖部35个,基底部宽度为(11.7±1.1)mm;其他部位13个,基底部宽度为(14.3±6.1)mm,两种方法的检出率和基底部宽度比较,差异均有统计学意义(均P<0.05)。室壁瘤的主要TTE特征为:(1)室壁局部变薄,呈瘤样膨出,其开口的内径大于瘤体内径,瘤体壁与心室壁互为延续;(2)瘤体收缩期基本无运动或呈反向运动,部分瘤体内可有附壁血栓。室壁瘤的主要LVO特征为:造影剂充填于整个左室心腔,能够清晰识别左心系统心内膜边界,局部室壁变薄和瘤样膨出,瘤体内充满造影剂,在收缩期呈反向运动或运动明显减弱。其中,功能性室壁瘤的局部室壁可在舒张期恢复正常形态,而解剖性室壁瘤的局部室壁在收缩期和舒张期均可见瘤样膨出。结论 TTE和LVO均可无创检测室壁瘤,对于心尖部室壁瘤和小室壁瘤的诊断,LVO优于TTE,具有重要的临床价值。

Objective To evaluate the application value of transthoracic echocardiography（TTE）and left ventricular opacification（LVO）in the diagnosis of coronary heart disease with ventricular aneurysm.Methods A total of 101 patients with coronary heart disease were confirmed by coronary angiography were included in this study,their ultrasound image characteristics and the detection rate of ventricular aneurysm were compared by TTE and LVO.Results Twelve of 101 patients with coronary heart disease were determined with ventricular aneurysm by TTE（11.9%）,7 in apex whose base width of ventricular aneurysms were（16.8±3.6）mm and 5 in the other part whose base width were（25.4±5.2）mm.43 patients were determined with ventricular aneurysm by LVO（42. 6 %）,there were 48 ventricular aneurysms,including 35 in apical,whose base width of ventricular aneurysms were（11.7±1.1）mm,and 13 in the other part,whose base width were（14.3±6.1）mm. There were significant difference of detection rate and the base width between two methods（all P0.05）.The main features of ultrasound image of TEE：（1）regional ventricle wall was thinned and aneurysmal bulged.The internal diameter of aneurysmal opening was larger than the diameter of aneurysmal body,and aneurysmal wall was connected to ventricular wall.（2）Aneurysmal wall showed no movement or paradoxical movement during systole,and mural thrombus was found in some aneurysms.The main features of ultrasound image of LVO：contrast agent was filled in left ventricle,which made left ventricular endocardial border more clearly identified.Regional ventricle wall was thinned and aneurysmal bulged.Aneurysm was filled with contrast agent,which showed reverse movement or decreased movement during systole.Aneurysmal wall of functional ventricular aneurysm could restore to normal morphology during diastole,while aneurysmal wall of anatomical aneurysm bulged during systolic and diastolic.Conclusion TTE and LVO both could detect ventricular aneurysm in noninvasive ways.The diagnosis of ventricular aneurysm in apical and tiny aneurysm by LVO is superior to TTE.