Nagy A, Temesvári A, Pártos O, Lengyel M
Gottsegen György Országos Kardiológiai Intézet, Budapest.
Orv Hetil. 2000 Nov 5;141(45):2439-42.
The aim of the study was to assess the accuracy of rest myocardial contrast echocardiography (MCE) in detecting perfusion abnormalities after intravenous contrast administration in chronic coronary artery disease. In 21 patients (mean age 49 years) contrast agent was injected intravenously. ATL HDI 5000 ultrasound machine was used. Triggering every fifth cardiac cycle in end-systole apical 2-chamber, 3-chamber and 4-chamber views were used. All patients underwent thallium scintigraphy on the same day and coronary angiography was performed within 24 hours. Second harmonic imaging and power Doppler were used in assessing presence or absence of perfusion, localization and extent of perfusion defects, and their relation with wall motion. In the first group all the 13 patients after myocardial infarction had akinetic segments on echocardiography in accordance with the coronary occlusion detected by coronary angiography. In the second group none of the 8 patients without previous myocardial infarction had wall motion abnormality. Group I: dividing the left ventricle into 16 segments out of 208 segments 44 were akinetic. Perfusion defect was detected by MCE in 29 segments. In 12 segments with wall motion abnormality the normal myocardial perfusion was consistent with viable myocardium, 2 inferior akinetic segments could not be evaluated due to contrast attenuation and in one inferior segment MCE in contrast to the thallium scintigraphy showed no perfusion defect. Group II: good contrast effect was detected in all 128 segments except one inferior segment in which there was a fixed perfusion defect also by thallium scintigraphy and coronary angiography revealed occluded right coronary artery. In conclusion MCE and second harmonic triggered imaging is comparable with thallium scintigraphy in detecting fixed perfusion abnormalities. MCE may contribute to the detection of viable myocardium.
本研究的目的是评估静息心肌对比超声心动图（MCE）检测慢性冠状动脉疾病患者静脉注射造影剂后灌注异常的准确性。对21例患者（平均年龄49岁）静脉注射造影剂。使用ATL HDI 5000超声仪。在收缩末期的心尖双腔、三腔和四腔视图中，每五个心动周期触发一次。所有患者在同一天接受铊闪烁扫描，并在24小时内进行冠状动脉造影。使用二次谐波成像和功率多普勒来评估灌注的有无、灌注缺损的定位和范围及其与壁运动的关系。第一组中，所有13例心肌梗死患者的超声心动图显示有运动减弱节段，与冠状动脉造影检测到的冠状动脉闭塞情况一致。第二组中，8例无既往心肌梗死的患者均无壁运动异常。第一组：将左心室分为208个节段中的16个节段，其中44个节段运动减弱。MCE检测到29个节段有灌注缺损。在12个有壁运动异常的节段中，正常心肌灌注与存活心肌一致，2个下壁运动减弱节段由于造影剂衰减无法评估，1个下壁节段MCE与铊闪烁扫描结果相反，未显示灌注缺损。第二组：除1个下壁节段外，所有128个节段均有良好的造影效果，该节段铊闪烁扫描也显示有固定灌注缺损，冠状动脉造影显示右冠状动脉闭塞。总之，MCE和二次谐波触发成像在检测固定灌注异常方面与铊闪烁扫描相当。MCE可能有助于检测存活心肌。
