【摘要】 目的评价左心室超声造影(LVO)在明确心肌梗死患者是否存在左心室附壁血栓、准确测量左心室射血分数(LVEF)以及监测抗凝治疗效果的临床应用价值。方法回顾性分析2015年8月至2016年10月中日友好医院收治的因常规超声心动图怀疑附壁血栓而行LVO的26例心肌梗死患者。6例患者抗凝治疗后3~11个月行LVO复查。采用配对资料的Mc Nemar检验比较常规超声心动图与LVO明确诊断存在及排除血栓比例差异;采用Bland-Altman分析不同年资超声医师间常规超声心动图、LVO测量LVEF的一致性。结果常规超声心动图明确诊断心尖部附壁血栓形成6例,排除血栓4例,可疑或不能确定16例。LVO明确诊断心尖部附壁血栓形成10例,排除血栓15例,不能确定1例。LVO明确诊断存在或排除心尖部血栓形成的比例高于常规超声心动图[96.2%(25/26)vs 38.5%(10/26)],且差异有统计学意义(χ2=13.067,P<0.001)。Bland-Altman分析图显示,高年资与低年资超声医师LVO测量LVEF的差值均数为1.5%,95%可信区间为(-9.6%,6.5%);高年资与低年资超声医师常规超声心动图测量LVEF的差值均数为3.5%,95%可信区间为(-23.9%,16.9%)。不同年资超声医师间LVO测量LVEF的一致性LVO优于常规超声心动图。6例患者抗凝治疗后复查LVO,1例血栓消失,4例血栓明显缩小,1例无明显变化。结论对怀疑有心尖部附壁血栓形成的心肌梗死患者,LVO能够明显增强诊断信心,更详尽描述血栓大小形态,增加测量LVEF的一致性,在对患者进行风险评估、抗凝策略制定以及连续监测治疗效果方面有潜在应用价值。更多还原

【Abstract】 Objective To demonstrate the clinical value of left ventricular opacification(LVO), compared to conventional echocardiography, on interpretation of apical thrombus, measuring left ventricular ejection fraction(LVEF), and monitoring the effects of anticoagulation. Methods This retrospective study included twenty-six myocardial infarction patients with suspected apical thrombus on routine echocardiography in China-Japan friendship hospital between August 2015 and October 2016. All patients underwent LVO using microbubble contrast agent(Sono Vue). Six patients had repeated LVO examination 3-11 months after anticoagulant therapy. The diagnostic performance of routine echocardiography and LVO were compared using Mc Nemar test. The interobserver agreement in measuring LVEF by conventional echocardiograph and LVO were analyzed using Bland-Altman analysis. Results Apical thrombus were diagnosed in 6 patients, excluded in 4 patients and inconclusive in 16 patients by routine echocardiography, while diagnosed in 10 patients, excluded in 15 patients and inconclusive in 1 patients by LVO. The inconclusive results were significantly improved when using LVO [96.2%(25/26) vs 38.5%(10/26)](χ2=13.067, P < 0.001). Bland-Altman chart showed the mean difference of LVEF by LVO between senior and junior doctors was 1.5%[95% CI(-9.6%, 6.5%)], while the mean difference was 3.5% [95%CI(-23.9%, 16.9%)] when using routine echocardiography. The interobserver agreement in measuring LVEF was better for LVO. Six patients were followed up 3-11 months after anticoagulation. Of them, 1 thrombus disappeared, 4 diminished and 1 had no significant change. Conclusion LVO has the potential value of improving the diagnosis of apical thrombus, assessment of LVEF, and monitoring of anticoagulation in myocardial infarction patients.更多还原