实时心肌对比超声心动图检测应激性心肌缺血。与99mTc-司他米比单光子发射计算机断层扫描的比较。
Real-time myocardial contrast echocardiography for the detection of stress-induced myocardial ischemia. Comparison with 99mTc-sestamibi single photon emission computed tomography.
作者信息
Dubart A-E, Carvalho da Silva K G, Korosoglou G, Bekeredjian R, Hansen A, Hardt S, Rosenberg M, Ferrari N, Hoerig B, Zehelein J, Kuecherer H
机构信息
Department of Cardiology, Innere Medizin III, Im Neuenheimer Feld, 69120 Heidelberg, Germany.
出版信息
Z Kardiol. 2004 Nov;93(11):890-6. doi: 10.1007/s00392-004-0144-7.
BACKGROUND
Real-time contrast echocardiography (MCE) is a new promising technique for assessing myocardial perfusion. The purpose of this study was to test whether realtime MCE can be used to detect functionally significant coronary artery stenosis in patients with known or suspected coronary artery disease. Myocardial contrast echocardiographic studies were compared with nearly simultaneous 99mTc-sestamibi single photon emission computed tomography (SPECT) as a clinical standard reference to evaluate regional myocardial perfusion defects.
METHODS
Real-time MCE based on continuous infusion of Optison (8-10 ml/h) was performed in 66 patients during standard 99mTc-SPECT dipyridamole (0.56 mg/kg x 4 min) stress testing. Images were obtained in apical 4- and 2-chamber views, each divided into 6 segments. Tracer uptake and myocardial opacification were visually analyzed for each segment by two pairs of blinded observers and graded as normal, mildly reduced, severely reduced, or absent. In 792 myocardial segments, myocardial opacification by MCE was uninterpretable in 143 (18%) segments and tracer uptake by SPECT was not clearly defined in 92 (12%) segments. Interobserver variability for MCE was good with concordance rates of 83% (kappa=0.72) for rest- and 86% (kappa=0.76) for stress images. Overall concordance between MCE and SPECT was good (83%, kappa=0.63) at a segmental level. In the diagnosis of fixed and reversible defects, and of normal perfusion, concordance rates were 73, 65 and 83%, respectively. When analysis was performed at the regional level, we found comparable levels of concordance rates for LAD (83%, kappa=0.59), LCX (86%, kappa=0.64) and RCA (80%, kappa=0.68) perfusion territories.
CONCLUSIONS
These findings suggest that realtime MCE is a clinically acceptable method to evaluate myocardial perfusion defects during dipyridamole stress testing.
背景
实时心肌对比超声心动图（MCE）是一种用于评估心肌灌注的有前景的新技术。本研究的目的是测试实时MCE是否可用于检测已知或疑似冠状动脉疾病患者的功能性显著冠状动脉狭窄。将心肌对比超声心动图研究与几乎同时进行的99mTc- sestamibi单光子发射计算机断层扫描（SPECT）作为评估局部心肌灌注缺损的临床标准参考进行比较。
方法
在66例患者进行标准99mTc-SPECT双嘧达莫（0.56mg/kg×4分钟）负荷试验期间，基于持续输注Optison（8 - 10ml/h）进行实时MCE。在心尖四腔和两腔视图中获取图像，每个视图分为6个节段。由两对不知情的观察者对每个节段的示踪剂摄取和心肌显影进行视觉分析，并分级为正常、轻度降低、重度降低或缺失。在792个心肌节段中，MCE的心肌显影在143个（18%）节段中无法解释，SPECT的示踪剂摄取在92个（12%）节段中未明确界定。MCE的观察者间变异性良好，静息图像的一致性率为83%（kappa = 0.72），负荷图像的一致性率为86%（kappa = 0.76）。在节段水平上，MCE和SPECT之间的总体一致性良好（83%，kappa = 0.63）。在固定和可逆缺损以及正常灌注的诊断中，一致性率分别为73%、65%和83%。当在区域水平进行分析时，我们发现左前降支（LAD，83%，kappa = 0.59）、左旋支（LCX，86%，kappa = 0.64）和右冠状动脉（RCA，80%，kappa = 0.68）灌注区域的一致性率水平相当。
结论
这些发现表明，实时MCE是在双嘧达莫负荷试验期间评估心肌灌注缺损的一种临床可接受的方法。
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