小剂量多巴酚丁胺负荷超声心动图结合多普勒组织成像评价存活心肌的研究

Evaluation of viable myocardium by combined low dose dobutamine echocardiography with Doppler tissue imaging test compared with 99m Tc-MIBI SPECT

目的 研究多普勒组织成像 (DTI)结合小剂量多巴酚丁胺负荷超声心动图评价心肌活性的可行性 ,并研究其与99mTc MIBI硝酸甘油介入心肌显像在评价存活心肌方面的一致性。方法 对 30例经冠状动脉造影确诊冠心病的患者行超声心动图及心脏核素检查。超声心动图检查使用DTI速度模式 ,采用两级多巴酚丁胺超声心动图试验。所有患者均行静息显像及硝酸甘油介入后显像。结果 ① 30例冠心病患者用超声心动图静息DTI检测 480个室壁节段 ,检出 166个运动异常节段 ,运动减弱节段 10 8个 ,运动消失节段 5 8个。②对患者行超声心动图小剂量多巴酚丁胺负荷试验DTI检测 480个室壁节段 ,检出 166个运动异常节段中 89个节段运动改善 ,提示为存活心肌节段 (A组 ) ;余 77个节段无变化 ,为坏死心肌 (B组 )。A组静息及负荷超声心动图DTI差异有显著性意义 (P <0 .0 5 ) ,B组静息及负荷超声心动图DTI差异无显著性意义 (P >0 .0 5 ) ,A组与B组静息超声心动图DTI差异无显著性意义 (P >0 .0 5 )。③ 30例冠心病患者用99mTc MIBI硝酸甘油介入心肌显像检测 480个室壁节段 ,检出 185个病变节段 ,其中 97个为存活心肌节段。小剂量多巴酚丁胺结合超声心动图DTI诊断存活心肌的敏感性达 83% ,特异性达 86%。结论 DTI结合小剂量多巴酚丁胺?

Objective To evaluate the myocardial viability by combining low dose dobutamine echocardiography (LDDE) with Doppler tissue imaging (DTI) test ,and to study the consistence between combined LDDE with DTI test and nitroglycerin (NTG) infusion tomography in evaluation of viable myocardium.Methods Thirty patients with coronary disease(CAD) confirmed by coronary angiography were measured by echocardiography and SPECT.Regional wall motion was measured by DTI at rest,during dobutamine infusion (5,10 μg·kg -1 ·min -1 ).The left ventricular wall motion at rest and intravenous infusion of NTG ( 0.5 ～ 1.0 mg) was assessed in 30 cases of CAD.Results Viability of myocardium detected by combining LDDE with DTI test was more frequent in hypokinetic segments than that in akinetic segments.Myocardial viability in the infarct zone by combining LDDE with DTI test was documented in 89 patients (group A) and absent in 77 patients (group B).There was difference between at rest and during dobutamine infusion in group A ( P < 0.05 ),while no difference in group B ( P > 0.05 ).There was no difference between group A and group B at rest in DTI echocardiography ( P > 0.05 ).Myocardial viability in the infarct zone by NTG infusion tomography was documented in 97 patients and absent in 88 patients.Regard the results of NTG infusion tomography as the standard,the sensitivity and specificity of diagnosis of viable myocardium by combined LDDE with DTI test were 83% and 86%,respectively.Conclusions Combining LDDE with DTI test can directly and quantitatively show abnormalities of left ventricular wall movement.It is a relatively reliable and ideal method for identifying viable myocardium.