慢性冠状动脉疾病患者中超声组织特征与背向散射积分与收缩储备的关系。

Relation of ultrasonic tissue characterization with integrated backscatter to contractile reserve in patients with chronic coronary artery disease.

作者信息

Hu Xiaojun, Wang Jinming, Sun Yougang, Jiang Xia, Sun Bin, Fu Haixia, Guo Ruiqiang

机构信息

Division of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. hxjsuper@.163.com

出版信息

Clin Cardiol. 2003 Oct;26(10):485-8. doi: 10.1002/clc.4960261010.

DOI:10.1002/clc.4960261010

PMID:14579920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654415/

Abstract

BACKGROUND

Previous studies have shown that viable but stunned myocardium displays contractile reserve and exhibits cardiac cycle-dependent variations of integrated backscatter (CVIB), whereas infarcted myocardium does not.

HYPOTHESIS

This study was designed to clarify whether assessment of the acoustic properties of the myocardium can predict contractile reserve in patients with chronic coronary artery disease (CAD).

METHODS

In all, 21 patients with chronic CAD and 19 normal control subjects were studied. The magnitude of CVIB of the myocardium was measured in the basal and mid segment of the anterior septum and posterior wall of the left ventricle, using a real-time, two-dimensional integrated backscatter imaging system. The results were compared with the percent systolic wall thickening and the wall motion before and after revascularization. The wall motion was graded as normal, hypokinetic, or akinetic, and contractile reserve was considered present when an akinetic or hypokinetic segment improved after revascularization.

RESULTS

The average magnitude of CVIB was lower among dysfunctional segments of CAD than among normal segments of controls (3.73 +/- 1.71 vs. 6.35 +/- 0.69, p < 0.001). Of the 77 segments examined, 38 showed reversible dysfunction. Before revascularization, percent systolic wall thickening was similar among segments showing contractile reserve compared with those with persistent dysfunction myocardium (17.97 +/- 8.41 vs. 16.83 +/- 6.37%, p = 0.19), and the mean CVIB was significantly greater in segments with than in those without contractile reserve (4.73 +/- 1.47 vs. 2.75 +/- 1.31, p < 0.001). The CVIB above 3 dB before percutaneous transluminal coronary angioplasty predicted segments with contractile reserve with a sensitivity and specificity of 84.2 and 79.5%, respectively.

CONCLUSIONS

Cardiac cycle-dependent variations of integrated backscatter reflected myocardial contractility and functional capacity of the myocardium. They predicted segmental contractile reserve in patients with CAD.

摘要

背景

先前的研究表明，存活但顿抑的心肌表现出收缩储备，并呈现出与心动周期相关的背向散射积分（CVIB）变化，而梗死心肌则不然。

假设

本研究旨在阐明对心肌声学特性的评估是否能够预测慢性冠状动脉疾病（CAD）患者的收缩储备。

方法

总共对21例慢性CAD患者和19名正常对照者进行了研究。使用实时二维背向散射积分成像系统，测量左心室前间隔和后壁基底段及中间段心肌的CVIB大小。将结果与血管重建前后的收缩期室壁增厚百分比和室壁运动情况进行比较。室壁运动分为正常、运动减弱或无运动，当无运动或运动减弱节段在血管重建后改善时，则认为存在收缩储备。

结果

CAD功能障碍节段的CVIB平均大小低于对照组正常节段（3.73±1.71对6.35±0.69，p<0.001）。在检查的77个节段中，38个显示可逆性功能障碍。血管重建前，显示有收缩储备的节段与持续性功能障碍心肌节段的收缩期室壁增厚百分比相似（17.97±8.41对16.83±6.37%，p = 0.19），有收缩储备节段的平均CVIB显著高于无收缩储备节段（4.73±1.47对2.75±1.31，p<0.001）。经皮腔内冠状动脉成形术（PTCA）前CVIB高于3 dB可预测有收缩储备的节段，敏感性和特异性分别为84.2%和79.5%。