Heinle S K, Noblin J, Goree-Best P, Mello A, Ravad G, Mull S, Mammen P, Grayburn P A
Department of Internal Medicine, UT Southwestern and Dallas VA Medical Centers, TX 75216, USA.
Circulation. 2000 Jul 4;102(1):55-60. doi: 10.1161/01.cir.102.1.55.
Harmonic power Doppler imaging (HPDI) is a novel technique for assessing myocardial perfusion by contrast echocardiography in humans. The purpose of this study was to compare myocardial perfusion by HPDI with that obtained by (99m)Tc-sestamibi single photon emission computed tomography (SPECT) during rest and pharmacological stress.
HPDI was performed on 123 patients who were referred for SPECT imaging for known or suspected coronary artery disease. Images were obtained at baseline and during adenosine infusion (0.14 mg. kg(-)(1). min(-)(1)x6 minutes) in 3 apical views. Myocardial perfusion by HPDI was graded for each coronary territory as absent, patchy, or full. The persistence of absent or patchy myocardial perfusion by HPDI between rest and adenosine was interpreted as a fixed defect, whereas any decrease in perfusion grade was interpreted as a reversible defect. Overall concordance between HPDI and SPECT was 83 (81%) of 103 for normal versus abnormal perfusion. Agreement between the 2 methods for each of the 3 coronary territories was 81% (kappa=0.57) for the left anterior descending artery, 76% (kappa=0.52) for the right coronary artery, and 72% (kappa=0.40) for the left circumflex artery. Discrepancies between the 2 techniques were most notable in the circumflex territory, where fixed defects were observed in 33% by HPDI but in only 14% by SPECT (chi(2)=15.8, P=0.0001).
This study demonstrates that HPDI can reliably detect myocardial perfusion during pharmacological stress, although there was a significantly higher number of falsely abnormal results in the circumflex territory.
谐波能量多普勒成像（HPDI）是一种通过超声心动图评估人体心肌灌注的新技术。本研究的目的是比较静息和药物负荷状态下HPDI与锝-99m 甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）所获得的心肌灌注情况。
对123例因已知或疑似冠状动脉疾病而接受SPECT成像检查的患者进行HPDI检查。在3个心尖视图下于基线状态及腺苷输注过程中（0.14 mg·kg⁻¹·min⁻¹×6分钟）获取图像。HPDI对每个冠状动脉区域的心肌灌注情况分为无灌注、斑片状灌注或完全灌注。HPDI显示静息和腺苷负荷状态下无灌注或斑片状心肌灌注持续存在被解释为固定性缺损，而灌注分级的任何降低被解释为可逆性缺损。正常与异常灌注情况下，HPDI与SPECT的总体一致性为103例中的83例（81%）。两种方法对三支冠状动脉各自区域的一致性分别为：左前降支81%（kappa=0.57），右冠状动脉76%（kappa=0.52），左旋支72%（kappa=0.40）。两种技术之间的差异在左旋支区域最为显著，HPDI显示33%存在固定性缺损，而SPECT仅显示14%（χ²=15.8，P=0.0001）。
本研究表明，HPDI能够可靠地检测药物负荷状态下的心肌灌注，尽管左旋支区域出现假阳性异常结果的数量显著更多。
