应用超声心动图运动异常节段推测梗死相关冠状动脉

Conjecture of coronary arteries of myocardial infarction related according to regional wall motion abnormality of left ventricle by two-dimensional echocardiography

目的 根据二维超声心动图 ( 2DE)对左室节段运动异常 (WMA)的定位及范围 ,推测心肌梗死相关冠状动脉(IRCA)。方法 对 10 5例心肌梗死患者先后进行 2DE和冠状动脉造影检查 ,根据 2DE检出WMA节段的部位和范围推测IR CA。以前间隔和前壁基、中段 ,及其心尖部 6个节段中任何≥ 3个相邻节段WMA时 ,IRCA推测为LAD ;以下、后壁基、中段和后间隔基段 5段中任何≥ 2相邻节段WMA时 ,推测为RCA ;以后、侧壁基、中段 4个节段中任何≥ 2个相邻节段WMA ,且未累及后间隔基段者 ,推测为LCX。将推测结果与冠状动脉造影的结果对比 ,计算 2DE推测IRCA的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果 2DE推测IRCA的敏感性、特异性、阳性预测值、阴性预测值和准确性结果在LAD均为 10 0 % ;在RCA分别为 86 4%、88 5 %、84 4%、90 0 %和 87 6% ;和在LCX分别为 81 0 %、91 7%、70 8%、95 0 %和 89 4%。结论 应用2DE检查的WMA定位可以较准确地推测IRCA。

Object To evaluate the conjecture accuracy by two-dimensional echocardiography (2DE) on the correlativity of the regional wall motion abnormality (RWMA) of position of left ventricle between the coronary artery occlusion.Methods 105 patients of myocardial infarction (MI) were underwent 2DE and coronary angiography (CAG) examination in our hospital.According to the position of RWMA of left ventricle revealed by 2DE to conject the infarcted relative coronary artery (IRCA).If whichever ≥3 adjacent segments were revealed RWMA on basal segment of anterior septum,of middle and of apex,and basal segment of anterior wall,of middle and of apex,and middle segment of posterior septum,It would be conjectured as left anterior descending artery(LAD)occlusion.If whichever ≥3 adjacent segments had RWMA on basal segment of posterior wall and middle,and basal segment lateral wall and middle,and without basal segment of posterior septum,it would be conjectured as left circumflex artery(LCX)occlusion.If basal segment of posterior septum and whichever ≥2 adjacent segments had RWMA on basal segment of inferior wall and middle,and basal segment of posterior wall and middle,it would be conjectured as right coronary artery (RCA) occlusion.Then,the results of conjecture with 2DE were compared with the actual results diagnosed by coronary angiography,calculate the sensitivity,specificity and accuracy of 2DE examination for conjecturing IRCA.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of conjecture results of relative with coronary arteries with echocardiography showed that LDA all were 100%;RCA were 86.4%、88.5%、84.4%、90.0% and 87.6%;LCX wre 81.0%、91.7%、70.8%、95.0% and 89.4% respectively.Conclusion According to RWMA of left ventricle with two-dimensional echocardigraphy may accurately conjecture IRCA.