脉冲波组织多普勒成像用于评估顿抑心肌、冬眠心肌和瘢痕心肌的收缩储备。

Pulsed wave tissue Doppler imaging for the quantification of contractile reserve in stunned, hibernating, and scarred myocardium.

作者信息

Bountioukos M, Schinkel A F L, Bax J J, Rizzello V, Valkema R, Krenning B J, Biagini E, Vourvouri E C, Roelandt J R T C, Poldermans D

机构信息

Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, Netherlands.

出版信息

Heart. 2004 May;90(5):506-10. doi: 10.1136/hrt.2003.018531.

DOI:10.1136/hrt.2003.018531

PMID:15084544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1768236/

Abstract

OBJECTIVES

To assess whether quantification of myocardial systolic velocities by pulsed wave tissue Doppler imaging can differentiate between stunned, hibernating, and scarred myocardium.

DESIGN

Observational study.

SETTING

Tertiary referral centre.

PATIENTS

70 patients with reduced left ventricular function caused by chronic coronary artery disease.

METHODS

Pulsed wave tissue Doppler imaging was done close to the mitral annulus at rest and during low dose dobutamine; systolic ejection velocity (Vs) and the difference in Vs between low dose dobutamine and the resting value (DeltaVs) were assessed using a six segment model. Assessment of perfusion (with Tc-99m-tetrofosmin SPECT) and glucose utilisation (by 18F-fluorodeoxyglucose SPECT) was used to classify dysfunctional regions (by resting cross sectional echocardiography) as stunned, hibernating, or scarred.

RESULTS

253 of 420 regions (60%) were dysfunctional. Of these, 132 (52%) were classified as stunned, 25 (10%) as hibernating, and 96 (38%) as scarred. At rest, Vs in stunned, hibernating, and scar tissue was, respectively, 6.3 (1.8), 6.6 (2.2), and 5.5 (1.5) cm/s (p = 0.001 by ANOVA). There was a gradual decline in Vs during low dose dobutamine infusion between stunned, hibernating, and scar tissue (8.3 (2.6) v 7.8 (1.5) v 6.8 (1.9) cm/s, p < 0.001 by ANOVA). DeltaVs was higher in stunned (2.1 (1.9) cm/s) than in hibernating (1.2 (1.4) cm/s, p < 0.05) or scarred regions (1.3 (1.2) cm/s, p = 0.001).

CONCLUSIONS

Quantitative tissue Doppler imaging showed a gradual reduction in regional velocities between stunned, hibernating, and scarred myocardium. Dobutamine induced contractile reserve was higher in stunned regions than in hibernating and scarred myocardium, reflecting different severities of myocardial damage.

摘要

目的

评估通过脉冲波组织多普勒成像对心肌收缩速度进行定量分析能否区分顿抑心肌、冬眠心肌和瘢痕心肌。

设计

观察性研究。

地点

三级转诊中心。

患者

70例因慢性冠状动脉疾病导致左心室功能减退的患者。

方法

在静息状态和低剂量多巴酚丁胺负荷试验时，于二尖瓣环附近进行脉冲波组织多普勒成像；采用六节段模型评估收缩期射血速度（Vs）以及低剂量多巴酚丁胺负荷试验时与静息值之间的Vs差值（ΔVs）。利用灌注评估（采用锝-99m-替曲膦单光子发射计算机断层显像）和葡萄糖利用评估（采用18F-氟脱氧葡萄糖单光子发射计算机断层显像），通过静息状态下的二维超声心动图将功能失调区域分类为顿抑、冬眠或瘢痕心肌。

结果

420个节段中有253个（60%）功能失调。其中，132个（52%）被分类为顿抑，25个（10%）为冬眠，9个6（38%）为瘢痕。静息状态下，顿抑心肌、冬眠心肌和瘢痕组织中的Vs分别为6.3（1.8）、6.6（2.2）和5.5（1.5）cm/s（方差分析，p = 0.001）。在低剂量多巴酚丁胺输注过程中，顿抑心肌、冬眠心肌和瘢痕组织的Vs呈逐渐下降趋势（分别为8.3（2.6）、7.8（1.5）和6.8（1.9）cm/s，方差分析，p < 0.001）。顿抑区域的ΔVs（2.1（1.9）cm/s）高于冬眠区域（1.2（1.4）cm/s，p < 0.05）或瘢痕区域（1.3（1.2）cm/s，p = 0.001）。