小剂量多巴酚丁胺负荷下超声斑点追踪技术与磁共振延迟增强显像技术评价陈旧性心肌梗死存活性研究

发布时间：2018-07-08 16:42

本文选题：心肌梗死 + 磁共振成像　；参考：《中国循环杂志》2017年11期

【摘要】：目的:比较磁共振延迟增强显像(DE-MRI)技术与小剂量多巴酚丁胺负荷斑点追踪超声(LDDS-STE)技术评价陈旧性心肌梗死患者存活心肌方面的敏感性和特异性。方法:选取30例本院住院陈旧性心肌梗死患者为研究对象。上述患者接受经皮冠状动脉介入治疗(PCI)术前进行心脏核磁共振检查及超声心动图检查,LDDS-STE方法分析静息和负荷条件下左心室室壁运动异常节段短轴径向应变(RS)及应变率(RSr),术后1,3,6个月复查超声心动图,观察室壁运动反常节段运动是否改善或恢复,以室壁运动分数改善作为判断存活心肌的金标准。结果:30例患者共获得510个左心室可分析节段,超声心动图判定室壁运动异常节段201个。与金标准比较,静息状态下左心室径向应变(RS_(rest))预测陈旧性心肌梗死患者存活心肌受试者工作特征(ROC)曲线下面积为0.636,敏感性为60.0%,特异性为60.5%;小剂量多巴酚丁胺负荷条件下左心室径向应变(RS_(LDDS))预测存活心肌ROC曲线下面积0.806,敏感性和特异性分别为79.1%及82.7%。静息状态下左心室径向应变率(RSr_(rest))预测陈旧性心肌梗死患者存活心肌敏感性为60.0%,特异性为60.5%,ROC曲线下面积0.646;小剂量多巴酚丁胺负荷条件下左心室径向应变率(RSr_(LDDS))预测存活心肌敏感性和特异性较静息状态下明显提高,分别为80.0%及83.7%,ROC曲线下面积0.808。DE-MRI技术预测存活心肌的敏感性和特异性分别为90.8%和87.1%,准确性89.5%,ROC曲线下面积为0.901。结论:DE-MRI与LDDS-STE方法均能准确识别梗死后存活心肌,但DE-MRI方法检测存活心肌的价值稍高于LDDS-STE,且准确率及重复性高,耗时短,为临床预测陈旧性心肌梗死患者PCI术的疗效及治疗策略的选择提供重要依据。
[Abstract]:Objective: to compare the sensitivity and specificity of delayed enhanced magnetic resonance imaging (DE-MRI) and low dose dobutamine stress spot tracing ultrasound (LDDS-STE) in evaluating viable myocardium in patients with old myocardial infarction. Methods: 30 old myocardial infarction patients in our hospital were selected. Cardiac MRI and echocardiography before percutaneous coronary intervention (PCI) and LDDS-STE were used to analyze the left ventricular wall motion abnormal segmental short axis radial strain (RS) under resting and loading conditions. The rate of variability (RSr), echocardiography was reexamined at 1 ~ 3 and 6 months postoperatively. Whether abnormal segmental motion of ventricular wall motion was improved or recovered was observed. The improvement of ventricular wall motion score was taken as the gold standard to judge the viable myocardium. Results 510 segments of the left ventricle were obtained from 30 patients and 201 segments of abnormal ventricular wall motion were determined by echocardiography. Compared with the gold standard, The radial strain of left ventricle (RS_ (rest) was used to predict the area under the operating characteristic curve (ROC) of surviving myocardial infarction patients in resting state was 0.636, the sensitivity was 60.010 and the specificity was 60.5.The left ventricular diameter was predicted under low dose dobutamine loading. The area under the ROC curve was 0.806, the sensitivity and specificity were 79.1% and 82.7%, respectively. In resting state, the radial strain rate of left ventricle (RSR _ (rest) was used to predict the survival myocardium of patients with old myocardial infarction. The sensitivity and specificity of the left ventricular radial strain rate (RSR _ (rest) were 60. 0 and 0. 646 under the ROC curve and 0. 646 under low dose dobutamine loading, respectively, and the left ventricular radial strain rate (RSR _ (LDDS) was predicted under low dose dobutamine loading. The sensitivity and specificity of active myocardium were significantly higher than those in resting state. The sensitivity and specificity of 0.808.DE-MRI in predicting viable myocardium were 90.8% and 87.1%, respectively. The accuracy was 89.5and the area under the ROC curve was 0.901.The area under the ROC curve was 0.808.DE-MRI, and the sensitivity and specificity were 90.8% and 87.1%, respectively. Conclusion both the WDE-MRI and LDDS-STE methods can accurately identify viable myocardium after infarction, but the value of DE-MRI in detecting viable myocardium is slightly higher than that of LDDS-STE, and the accuracy and repeatability are high, and the time consuming is short. To provide important basis for clinical prediction of the effect of PCI and the choice of treatment strategy in patients with old myocardial infarction.
【作者单位】：徐州医科大学附属医院心内科;徐州医科大学附属医院心血管病研究所;徐州医科大学附属医院放射科;
【分类号】：R542.22

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