Morello Mara, Bricco Giuliana, Calachanis Marco, Paglia Irene, Sheiban Imad, Mangiardi Lucia, Trevi Gian Paolo
Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy.
Ital Heart J. 2004 Jul;5(7):530-5.
Successful reperfusion therapy in patients with acute myocardial infarction (AMI) improves survival. Indeed, after AMI myocardial dysfunction may be reversible (hibernating or stunned myocardium). Low-dose dobutamine stress echocardiography (LDDSE) provides us with the possibility of evaluating viable myocardial segments, while myocardial contrast echocardiography (MCE) allows the study of the microcirculation in the same myocardial areas. The aim of our study was to compare LDDSE and MCE, in the prediction of the recovery of segments in patients with AMI who were submitted to primary coronary angioplasty (PTCA).
We studied 14 patients with AMI. Both LDDSE and MCE with Levovist were performed after primary PTCA. The viability gold standard was a recovery of contractility detected at echocardiography 2 months later.
For LDDSE, the sensitivity was 91%, the specificity 71% and the positive and negative predictive values were 93 and 64% respectively. For MCE, the sensitivity was 94%, the specificity 44%, the positive predictive value 89%, and the negative predictive value 59%. Two tests agreed in 81% of the cases. Stress echocardiography and contrast echocardiography agreed in 81% of cases.
LDDSE has a very good positive accuracy, it has an acceptable negative predictive value and is relatively cheap. On the other hand, MCE has a good positive accuracy, but a low negative accuracy and carries a high cost. The integration of these two tests, which are too expensive in clinical practice, could improve our comprehension of the post-PTCA pathophysiology.
急性心肌梗死（AMI）患者成功的再灌注治疗可提高生存率。事实上，AMI后心肌功能障碍可能是可逆的（心肌冬眠或心肌顿抑）。小剂量多巴酚丁胺负荷超声心动图（LDDSE）为我们评估存活心肌节段提供了可能，而心肌对比超声心动图（MCE）则可研究相同心肌区域的微循环。我们研究的目的是比较LDDSE和MCE在预测接受直接冠状动脉血管成形术（PTCA）的AMI患者节段恢复情况方面的差异。
我们研究了14例AMI患者。在直接PTCA后进行了LDDSE和使用Levovist的MCE检查。存活心肌的金标准是2个月后超声心动图检测到的收缩力恢复。
对于LDDSE，敏感性为91%，特异性为71%，阳性和阴性预测值分别为93%和64%。对于MCE，敏感性为94%，特异性为44%，阳性预测值为89%，阴性预测值为59%。两种检查在81%的病例中结果一致。负荷超声心动图和对比超声心动图在81%的病例中结果一致。
LDDSE具有非常好的阳性准确性，其阴性预测值可接受且相对便宜。另一方面，MCE具有良好的阳性准确性，但阴性准确性较低且成本高昂。这两种在临床实践中成本过高的检查相结合，可能会增进我们对PTCA后病理生理学的理解。
