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黎爱峰,刘霞,杨锐英,李娟,黎萍.多巴酚丁胺负荷试验结合脉冲组织多普勒二尖瓣环运动定量评估心肌梗死患者心肌存活[J].中国医学影像技术,2005,21(2):214~218

多巴酚丁胺负荷试验结合脉冲组织多普勒二尖瓣环运动定量评估心肌梗死患者心肌存活

Dobutamine stress test combining with mitral annular motion velocity of pulsed Doppler tissue imaging in quantitative assessment of myocardial viability in patients with myocardial infarction

投稿时间：2004-09-23 修订日期：2004-12-30

DOI：

中文关键词: 多普勒组织成像多巴酚丁胺心肌存活二尖瓣环

英文关键词:Doppler tissue imaging Dobutamine Myocardial viability Mitral annular

基金项目:宁夏回族自治区科委攻关项目(C1012)。

作者	单位	E-mail
黎爱峰	银川市第一人民医院心内科,宁夏银川 750001	Liaf3007@163.com
刘霞	宁夏医学院附属医院,宁夏银川 750004
杨锐英	宁夏医学院附属医院,宁夏银川 750004
李娟	宁夏医学院附属医院,宁夏银川 750004
黎萍	宁夏医学院化学教研室,宁夏银川 750004

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中文摘要:

目的研究脉冲多普勒组织成像技术(DTI-PW)中二尖瓣环速度检测存活心肌的可行性及价值。方法 40例陈旧性心肌梗死患者室壁按照硝酸甘油(NTG)介入⁹⁹Tc^m-MIBI SPECT结果分为有存活心肌组、无存活心肌组,采用小剂量多巴酚丁胺负荷超声心动图试验,测量相应梗死壁二尖瓣环多巴酚丁胺(Dobutamine,Dob)负荷前及每级Dob负荷试验时的收缩期峰值速度Vs、射血前期PEP、射血期ET;另选20例年龄匹配的正常人为对照组,测量6个室壁二尖瓣环Vs、PEP、ET。结果 Dob 5 μg/(kg·min)时,以Vs增加量≥2 cm/s为临界值,则检测存活心肌的敏感度为75%,特异度为76%,准确度为75％,以PEP/ET变化率2(Dob 5 μg/(kg·min)时PEP/ET与Dob负荷前PEP/ET的比值)≥100％作为诊断无存活心肌的临界值,则敏感度为73％,特异度为85％,准确度为79％;以Dob 10 μg/(kg·min)时Vs增加量≥3 cm/s为临界值,则检测存活心肌的敏感度增加到83%,特异度为79%,准确度增加到81％,以PEP/ET变化率3(Dob 10 μg/(kg·min)时PEP/ET与Dob负荷前PEP/ET的比值)≥100％作为诊断非存活心肌的临界值,则敏感度为82％,特异度为85％,准确度为84％。结论 Dob负荷时二尖瓣环Vs、PEP/ET可用于检测存活心肌,方法简单、可靠。

英文摘要:

Objective To investigate the correlation between myocardial viability and regional mitral annular motion velocity responding to dobutamine stress in patients with old myocardium infarction (OMI) with pulsed Doppler tissue imaging. Methods Forty patients with OMI and 20 age-matched normal subjects were included. ⁹⁹Tc^m-methoxyisobutylisonitrile scintigraphy was performed to divide the patients' left ventricular walls into two groups: the viable myocardium group and the non-viable myocardium group. Dobutamine was infused at low dose, and the peak systolic velocity (Vs), pre-ejection period (PEP) and ejection time (ET) were measured at the level of the mitral annular corresponding to the infarct regions in the OMI group and to the 6 mitral annular sites in the control group at baseline and every step of dobutamine infusion. Results When dobutamine was infused at 5 μg/(kg·min), assumed increase of Vs ≥2.0 cm/s, viable myocardium was detected with a sensitivity of 75%, a specificity of 76% and an accuracy of 75%. Assumed %PEP/ET₂ (the ratio of PEP/ET of 5 μg/(kg·min) Dobutamine to PEP/ET of rest) ≥ 100%, non-viable myocardium was detected with a sensitivity of 73%, a specificity of 85% and an accuracy of 79%. When dobutamine was infused at 10 μg/(kg·min), assumed increase of Vs ≥3.0 cm/s, viable myocardium was detected with a sensitivity of 83%, a specificity of 79% and an accuracy of 81%. Assumed %PEP/ET₃ (the ratio of PEP/ET of 10 μg/(kg·min) Dobutamine to PEP/ET of rest) ≥ 100%, non-viable myocardium was detected with a sensitivity of 82%, a specificity of 85% and an accuracy of 84%. Conclusion Viable myocardium can be identified with peak systolic mitral annular velocity and %PEP/ET during Dobutamine infusion.

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