【摘要】 目的探讨心肌造影超声心动图（MCE）联合多巴酚丁胺负荷超声心动图（DSE）定量评价动脉粥样硬化性心脏病即冠心病患者心肌血流灌注的临床价值,及不同程度狭窄冠状动脉供血心肌的微循环变化特点。方法 32例临床确诊的冠心病患者进行MCE联合DSE即心肌造影多巴酚丁负荷超声心动图（MCE-DSE）检查,根据冠状动脉造影结果将不同程度狭窄冠状动脉供血心肌按超声心动图16节段法进行分组:A组（狭窄率<50%,n=152）,B组（狭窄率50%～69%,n=124）,C组（狭窄率70%～89%,n=116）,D组（狭窄率≥90%,n=70）。采集静息及峰值负荷时的左心室心尖四腔、两腔和三腔心切面的心肌灌注动态图像,分析静息及负荷状态各组灌注参数A值（反映心肌血容量）、β值（反映心肌血流灌注平均速度）和A×β值（反映心肌的血流量）的差异。结果静息状态D组心肌灌注参数明显低于其他三组（P<0.001）。峰值负荷状态,A组、B组和C组心肌灌注参数较静息状态均明显增高（均P<0.001）,D组各参数变化不明显（均P>0.05）; A组和B组心肌灌注参数高于C组和D组,D组较其他三组明显降低（均P<0.001）。β储备值从A组到D组呈逐渐递减,C组及D组A值和A×β值明显低于A组和B组,D组降低更显著（均P<0.001）。以峰值负荷β值0.41 S^-1、A×β值2.17 dB·S^-1为临界值预测冠状动脉狭窄>70%的敏感度和特异度分别为78.5%、87.5%和87.1%、85.0%。结论 MCE-DSE诊断冠状动脉狭窄有较高的敏感度和准确性,并可定量评价左心室心肌微循环灌注储备功能,随冠状动脉阻塞性狭窄程度增加,微循环灌注及储备功能逐渐降低。更多还原

【Abstract】 Objective To explore the clinical value of myocardial contrast echocardiography（MCE） combined with dobutamine stress echocardiography（DSE） on quantitative evaluation of myocardial perfusion in patients with coronary heart disease,and assess characteristics of myocardial microcirculations in different graded coronary artery stenosis. Methods MCE and DSE examinations were performed in 32 patients with coronary heart disease. Based on the 16 segment model of echocardiography,ischemic myocardium in different degree of stenosis diagnosed by coronary angiography were classified into 4 groups: A（<50%,n = 152）,B（50% ～ 69%,n = 124）,C（70% ～ 89%,n = 116） and D（≥90%,n= 70）. At rest and peak-dose of dobutamine,dynamic images of myocardial perfusion in the apical view of four,two and threechamber were acquired,and parametric differences of plateau value A,slope β and product of A×β respectively reflecting myocardial blood volume,mean velocity of myocardial perfusion and myocardial blood flow were analyzed. Results Parametric values of myocardial perfusion（PVMPs） were significantly lower in group D than in other three groups at rest（all P<0. 001）. Compared with rest state,PVMPs at peak-dose were increased obviously in group A,B and C（all P<0. 001） but not in group D（P>0. 05）. PVMPs of group A and B were higher than those of group C and D,group D was significantly lower than those of the other three groups（all P<0. 001） ． β reserve values from group A to D were gradually decreased,and values of A and A×β were significantly lower in group C and D than in group A and B with a more dramatic decline in D group（all P<0. 001）. The sensitivity and specificity to predict >70% of coronary artery stenosis with thresholds of β = 0. 41 S^-1 and A×β = 2. 17 dB·S^-1 at peak-dose load were 78. 5%,87. 5% and 87. 1%,85. 0%respectively. Conclusion With high sensitivity and accuracy in diagnosis of obstructive coronary artery stenosis,MCE combined with DSE possesses the potential to quantitatively evaluate myocardial microcirculation perfusion and reserve function of left ventricle,which would be gradually decreased along with the ascended degree of obstructive coronary artery stenosis.更多还原