Korosoglou G, Hansen A, Bekeredjian R, Filusch A, Hardt S, Wolf D, Schellberg D, Katus H A, Kuecherer H
Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
Heart. 2006 Mar;92(3):350-6. doi: 10.1136/hrt.2005.064246. Epub 2005 Jun 6.
To evaluate whether myocardial parametric imaging (MPI) is superior to visual assessment for the evaluation of myocardial viability.
Myocardial contrast echocardiography (MCE) was assessed in 11 pigs before, during, and after left anterior descending coronary artery occlusion and in 32 patients with ischaemic heart disease by using intravenous SonoVue administration. In experimental studies perfusion defect area assessment by MPI was compared with visually guided perfusion defect planimetry. Histological assessment of necrotic tissue was the standard reference. In clinical studies viability was assessed on a segmental level by (1) visual analysis of myocardial opacification; (2) quantitative estimation of myocardial blood flow in regions of interest; and (3) MPI. Functional recovery between three and six months after revascularisation was the standard reference. In experimental studies, compared with visually guided perfusion defect planimetry, planimetric assessment of infarct size by MPI correlated more significantly with histology (r2 = 0.92 versus r2 = 0.56) and had a lower intraobserver variability (4% v 15%, p < 0.05). In clinical studies, MPI had higher specificity (66% v 43%, p < 0.05) than visual MCE and good accuracy (81%) for viability detection. It was less time consuming (3.4 (1.6) v 9.2 (2.4) minutes per image, p < 0.05) than quantitative blood flow estimation by regions of interest and increased the agreement between observers interpreting myocardial perfusion (kappa = 0.87 v kappa = 0.75, p < 0.05).
MPI is useful for the evaluation of myocardial viability both in animals and in patients. It is less time consuming than quantification analysis by regions of interest and less observer dependent than visual analysis. Thus, strategies incorporating this technique may be valuable for the evaluation of myocardial viability in clinical routine.
评估心肌参数成像（MPI）在评估心肌存活性方面是否优于视觉评估。
通过静脉注射声诺维，对11头猪在左前降支冠状动脉闭塞前、闭塞期间及闭塞后进行心肌对比超声心动图（MCE）评估，并对32例缺血性心脏病患者进行评估。在实验研究中，将MPI评估的灌注缺损面积与视觉引导下的灌注缺损面积测量法进行比较。坏死组织的组织学评估作为标准参照。在临床研究中，通过以下方法在节段水平评估心肌存活性：（1）心肌显影的视觉分析；（2）感兴趣区域心肌血流的定量估计；（3）MPI。血运重建后三到六个月的功能恢复作为标准参照。在实验研究中，与视觉引导下的灌注缺损面积测量法相比，MPI对梗死面积的测量评估与组织学的相关性更强（r2 = 0.92对r2 = 0.56），且观察者内变异性更低（4%对15%，p < 0.05）。在临床研究中，MPI在检测心肌存活性方面比视觉MCE具有更高的特异性（66%对43%，p < 0.05）和良好的准确性（81%）。它比通过感兴趣区域进行定量血流估计耗时更少（每张图像3.4（1.6）分钟对9.2（2.4）分钟，p < 0.05），并提高了观察者之间对心肌灌注解读的一致性（kappa = 0.87对kappa = 0.75，p < 0.05）。
MPI在评估动物和患者的心肌存活性方面均有用。它比通过感兴趣区域进行定量分析耗时少，且比视觉分析对观察者的依赖性小。因此，在临床常规中纳入该技术的策略对于评估心肌存活性可能具有重要价值。
