小剂量多巴酚丁胺负荷超声心动图联合心肌声学造影评估冠心病患者经皮冠状动脉介入术后心肌灌注

Evaluation of myocardial perfusion in coronary heart disease patients after percutaneous coronary intervention by low-dose dobutamine stress echocardiography combined with myocardial contrast echocardiography

目的应用小剂量多巴酚丁胺负荷超声心动图(LDDSE)联合心肌声学造影(MCE)评估冠心病患者经皮冠状动脉介入(PCI)术后心肌灌注情况,探讨其临床应用价值。方法选取我院收治的冠心病患者32例,于PCI术前及PCI术后3个月、12个月行LDDSE联合MCE检查,比较PCI术前后正常心肌与坏死心肌灌注情况。依据随访结果将32例患者分为预后不良组11例和预后良好组21例,比较两组PCI术后心肌灌注情况。绘制受试者工作特征(ROC)曲线分析LDDSE联合MCE预测冠心病患者预后的诊断效能。结果LDDSE联合MCE检查显示,PCI术前冠心病患者坏死心肌造影剂最大微泡数值(A)、充填速度(β)、心肌血流量(A×β)均低于正常心肌,差异均有统计学意义(均P<0.05);PCI术后3个月、12个月坏死心肌A、β、A×β均高于PCI术前,但低于正常心肌,差异均有统计学意义(均P<0.05);PCI术后3个月、12个月坏死心肌A、β、A×β比较差异均无统计学意义。预后不良组PCI术后3个月坏死心肌A、β、A×β均低于预后良好组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,LDDSE联合MCE测量PCI术后3个月坏死心肌A、β、A×β预测冠心病患者预后的曲线下面积分别为0.892、0.853、0.801。结论LDDSE联合MCE可以准确评估冠心病患者PCI术后心肌灌注情况,在预测冠心病患者预后方面具有较好的临床应用价值。

Objective To evaluate the myocardial perfusion in coronary heart disease patients after percutaneous coronary intervention(PCI)by low-dose dobutamine stress echocardiography(LDDSE)combined with myocardial contrast echocardiography(MCE),and to explore its clinical application value.Methods A total of 32 patients with coronary heart disease who underwent PCI in our hospital were selected.All patients underwent LDDSE combined with MCE before PCI and 3 months,12 months after PCI.The perfusion conditions of normal and necrotic myocardia were compared before and after PCI.32 patients were divided into the poor prognosis group(n=16)and the good prognosis group(n=21)according to the follow-up results,the condition of myocardial perfusion after PCI between two groups was compared.Receiver operating characteristic(ROC)curve was drawn to analyze the prognostic value of necrotic myocardial perfusion by LDDSE combined with MCE after PCI.Results Before PCI,the maximum number of microbubbles(A),filling velocity(β)and myocardial blood flow volume(A×β)of the necrotic myocardium measured by LDDSE combined with MCE were lower than those of normal myocardium,the differences were statistically significant(all P<0.05).The A,βand A×βof the necrotic myocardium at 3 months and 12 months after PCI were higher than those before PCI,and lower than those of normal myocardium,the differences were statistically significant(all P<0.05).There were no statistically significant difference in A,βand A×βat 3 months and 12 months after PCI.The A,βand A×βof the necrotic myocardium at 3 months after PCI in the poor prognosis group were lower than those in the good prognosis group,the differences were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of A,βand A×βmeasured by LDDSE combined with MCE were 0.892,0.853 and 0.801,respectively.Conclusion LDDSE combined with MCE can accurately evaluate myocardial perfusion in patients with coronary heart disease after PCI,and has a good value in predicting prognosis.