左心心肌声学造影在冠心病心肌缺血患者中的诊断价值

Diagnostic value of left ventricular myocardial contrast echocardiography in patients with myocardial ischemia of coronary heart disease

目的探讨左心心肌声学造影在冠状动脉粥样硬化性心脏病(冠心病)心肌缺血患者中的诊断价值。方法选取2022年1月至2022年6月于应急总医院内科诊断为冠心病心肌缺血患者68例,先行经胸超声心动图检查(TTE),观察并记录不同节段性室壁运动异常,评价心肌供血情况,行心肌声学造影,观察心肌灌注情况。将两次评价结果与冠状动脉造影(CAG)结果进行对比。结果68例患者均行冠状动脉造影检查,结果显示51例患者均有不同程度的狭窄,其中轻度狭窄8例,中度狭窄15例,重度狭窄28例。TTE显示室壁运动减低阳性38例,阴性30例,其中阳性患者中轻度狭窄6例,中度狭窄15例,重度狭窄17例;心肌声学造影检查心肌灌注异常阳性51例,阴性17例,其中阳性患者中轻度狭窄10例,中度狭窄14例,重度狭窄27例。结果发现心肌灌注检出率明显高于TTE检出率,其敏感性和特异性均高于TTE。结论心肌声学造影对冠心病心肌缺血患者的诊断符合率明显高于经胸超声心动图,心肌声学超声造影对不同部位心肌灌注显像诊断准确性高,安全性高,具有较高的临床应用价值。

Objective To discuss the diagnostic value of left ventricular myocardial contrast echocardiography(MCE)in patients with myocardial ischemia of coronary heart disease(CHD).Methods CHD patients with myocardial ischemia(n=68)were chosen from Department of Internal Medicine of Emergency General Hospital from Jan.2022 to June 2022.The patients were firstly given examination of transthoracic echocardiography(TTE)for observing and recording differentregional wall motion abnormalities(RWMA),and reviewing myocardial blood supply.The patients were secondly given ultrasonic myocardial contrast echocardiography(MCE)for observing myocardial perfusion.The results of TTE and MCE were compared with results of coronary angiography(CAG).Results All patients(n=68)were received CAG examination,and results showed that there were 51 patients with stenosis in varying degrees,including 8 cases of mild stenosis,15 cases of moderate stenosis and 28 cases of severe stenosis.The results off TTE examination showed that there were 38 patients with positive and 30 with negative lower ventricular wall motion,and there were 6 cases of mild stenosis,15 of moderate stenosis and 17 of severe stenosis among patients with positive lower ventricular wall motion.The results of MCE examination showed that there were 51 patients with positive and 17 with negative myocardial perfusion abnormalities,including 10 cases of mild stenosis,14 of moderate stenosis and 27 of severe stenosis among patients with positive lower ventricular wall motion.The detection rate of MCE,sensitivity and specificity for myocardial perfusion abnormalities were higher than those of TTE.Conclusion The diagnostic compliance rate of MCE is significantly higher than that of CAG in CHD patients with myocardial ischemia.MCE has higher accuracy and safety in diagnosis of myocardialperfusion abnormalities at different sites with a higher clinical application value.