多普勒组织成像和二维超声诊断心肌梗死患者22例的应用研究

DIAGNOSESING 22 CASES OF MYOCARDIAL INFARCTIONBY DTI VELOCITY MODE IN CONTRASTTO 2D ECHOCARDIOGRAPHY

目的 观测比较正常室壁心肌和梗死心肌的运动速度,评估多普勒组织成像(DTI)速度图对冠心病梗死心肌的诊断价值。方法 心肌梗死患者22例,其中前间壁梗死组14例和下后壁梗死组8例,健康人48例作对照,分别行二维超声检查,在6个切面[ap4cv、ap2cv、alax、pslax、pssax(CT)、pssax(PM)]上按左室壁16节段分段法观测局部室壁心肌运动并记录运动异常节段,在alax上测量室壁节段厚度;在每一切面上切换为DTI速度图,测算各室壁节段心肌运动频谱曲线的速度指标(Sm、Em、MVGs、MVGe)。对PW-DTI与二维超声检测梗死和缺血心肌的诊断结果作比较。结果 PW-DTI速度图对心梗患者室壁运动异常节段总的检出率较之二维超声显著高(前间壁梗死组:43%、25%;下后壁梗死组:38%、23%,P均<0.01),其检测梗死和缺血心肌的准确性、敏感性高于二维超声(52.1%、43.8%;51.8%、30.3%),敏感性差异有显著性(P<0.05),其特异性低于二维超声,差异有显著性(52.5%、62.5%,P<0.05)。结论 DTI诊断冠心病心肌梗死优于二维超声。

Objective: To evaluate the diagnostic value of Doppler tissue imaging (DTI) for detection of infarction myocardium in coronary heart disease. Methods: Ventricular wall motions of 22 patients with myocardial infarction(MI) (anterior: 14; inferior: 8) and 48 healthy persons were examined. In 6 views(ap4cv, ap2cv, alax, pslax, pssax(CT), pssax(PM)), the regional left ventricular wall motion was observed by 2D echocardiography according to 16 segments and the abnormal movement was recorded. The thickness of myocardial segments was measured in alax. Having switched to DTI in each view, velocities (Sm, Em, MVGs, MVGe) of all segments' spectrum curve of ventricular wall motion were calculated or measured by pulsed wave-DTI (FW-DTI). The diagnostic result of PW-DTI for detection of myocardium in myocardial infarction and myocardium in myocardial ischemia was compared with that of 2D echocardio-graphy. Results: The total positive rate of PW-DTI for detection of segments whose ventricular wall motion was abnormal was significantly larger than that of 2D echocardiography( P <0.01). The accuracy and sensibility of PW-DTI for detection of myocardium in myocardial infarction and in myocardial ischemia were both larger than those of 2D echocardiography, but the specificity of PW-DTI was smaller than that of 2D echocardiography. The difference of sensibility and of specificity was respectively significant between PW-DTI and 2D echocardiography(P<0.05). Conclusions: The diadynamic value of DTI for detection of infarction myocardium in coronary heart disease is more excellent than that of 2D echocardiography.