Palagi Caterina, Mengozzi Giovanna, Rovai Daniele, Volterrani Duccio, Dell'Anna Rita, Giorgi Davide, Petronio Anna Sonia, Di Bello Vitantonio, Mariani Mario
Cardiothoracic Department, Pisa University, Pisa, Italy.
Echocardiography. 2003 Jan;20(1):37-45. doi: 10.1046/j.1540-8175.2003.00005.x.
The aim of the study was to evaluate the accuracy of intermittent, harmonic power Doppler (HPD) during intravenous Levovist infusion in identifying myocardial perfusion abnormalities in patients with recent infarction. Fifty-five patients with first acute myocardial infarction, successfully treated by primary PTCA, were studied after 1 month by myocardial contrast echocardiography (MCE), 99mTc tetrofosmin single photon emission computed tomography (SPECT), and low dose dobutamine echocardiography (DE). Scoring myocardial perfusion as normal, moderately, or severely reduced; MCE and SPECT were in agreement in 71% of segments(k = 0.414). Discordance was mainly due to ventricular walls with normal enhancement by MCE and moderate perfusion abnormalities by SPECT. Scoring perfusion as present or absent, the agreement significantly improved up to 86% (k = 0.59). Sensitivity and specificity of HPD for identifying SPECT perfusion defects were 63% and 93%, respectively. The agreement between MCE and SPECT was higher(85%, k = 0.627)in patients with anterior infarction. An improvement in regional contractile function was noted after dobutamine in 79 dysfunctional segments. A normal perfusion or a moderate perfusion defect by MCE were detected in 71 of 79 of these segments, while a severe perfusion defect was observed in 59 of 85 ventricular segments without dobutamine-induced wall-motion improvement. Sensitivity and specificity by HPD in detecting segments with contractile reserve were 90% and 69%, respectively. Thus, intermittent HPD during Levovist infusion allows myocardial perfusion abnormalities to be detected in patients with recent infarction. This method has a limited sensitivity but a high specificity in detecting SPECT perfusion defects, and a good sensitivity but a limited specificity in detecting contractile reserve.
本研究的目的是评估静脉注射声诺维期间间歇性谐波功率多普勒（HPD）在识别近期梗死患者心肌灌注异常方面的准确性。55例首次急性心肌梗死患者经直接经皮冠状动脉腔内血管成形术（PTCA）成功治疗，1个月后通过心肌对比超声心动图（MCE）、99m锝替曲膦单光子发射计算机断层扫描（SPECT）和低剂量多巴酚丁胺超声心动图（DE）进行研究。将心肌灌注分为正常、中度或严重降低；MCE和SPECT在71%的节段中结果一致（k = 0.414）。不一致主要是由于MCE显示增强正常而SPECT显示中度灌注异常的心室壁。将灌注分为存在或不存在时，一致性显著提高至86%（k = 0.59）。HPD识别SPECT灌注缺损的敏感性和特异性分别为63%和93%。前壁梗死患者中MCE和SPECT之间的一致性更高（85%，k = 0.627）。79个功能失调节段在多巴酚丁胺注射后区域收缩功能有所改善。在这些节段中的79个节段中有71个检测到MCE显示正常灌注或中度灌注缺损，而在85个未因多巴酚丁胺诱发室壁运动改善的心室节段中有59个观察到严重灌注缺损。HPD检测有收缩储备节段的敏感性和特异性分别为90%和69%。因此，声诺维注射期间的间歇性HPD可检测近期梗死患者的心肌灌注异常。该方法在检测SPECT灌注缺损时敏感性有限但特异性高，在检测收缩储备时敏感性良好但特异性有限。
