Sbano João Cesar Nunes, Tsutsui Jeane Mike, Andrade José Lazaro, Carlos Nicolau José, Meneghetti José Claudio, Franchini Ramires José, Mathias Wilson
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Echocardiography. 2005 Jul;22(6):496-502. doi: 10.1111/j.1540-8175.2005.04007.x.
We studied the value of low-dose dobutamine stress echocardiography (LDDE) and myocardial contrast echocardiography (MCE) in early prediction of left ventricular functional recovery (LVFR) after acute myocardial infarction (AMI) treated with successful thrombolysis.
LDDE and MCE using second-harmonic intermittent imaging were performed in first week after AMI. LVFR was defined as an absolute > or =5% increase in ejection fraction, from early to 6 months of follow-up by Technetium-99m-Sestamibi single-photon emission computed tomography.
Out of 50 patients studied, 19 evolved with LVFR (group 1) and 31 without LVFR (group 2). Regional dysfunction was detected in 103 (37%) infarcted-related segments in group 1 and in 173 (63%) segments in group 2.
Sensitivity, specificity, positive, and negative predictive values and accuracy for detecting LVFR by LDDE were 94.7% (18/19), 87.1% (27/31), 81.8% (18/22), 96.4% (27/28), and 90% (45/50), respectively, and by MCE were 94.7% (18/19), 51.6% (16/31), 54.5% (18/33), 94.1% (16/17), and 68% (34/50). In group 1, functional improvement was observed in 86.9% (53/61) of segments with contractile reserve by LDDE and in 65.8% (52/79) of segments with microvascular perfusion by MCE. In group 2, functional improvement was observed in 78.3% (18/23) of segments with contractile reserve by LDDE and in 25.5% (25/98) of segments with microvascular perfusion by MCE. All segments without perfusion by MCE evolved without functional recovery.
LDDE was an accurate predictor of late left ventricular function recovery after AMI, while MCE was sensitive and has a high negative predictive value demonstrating that microvascular perfusion is essential for LVFR.
我们研究了小剂量多巴酚丁胺负荷超声心动图（LDDE）和心肌对比超声心动图（MCE）在成功溶栓治疗的急性心肌梗死（AMI）后早期预测左心室功能恢复（LVFR）中的价值。
在AMI后的第一周进行使用二次谐波间歇成像的LDDE和MCE检查。LVFR定义为随访早期至6个月时射血分数绝对增加≥5%，通过锝-99m-甲氧基异丁基异腈单光子发射计算机断层扫描测定。
在研究的50例患者中，19例出现LVFR（第1组），31例未出现LVFR（第2组）。第1组梗死相关节段中有103个（37%）检测到节段性功能障碍，第2组中有173个（63%）节段出现该情况。
LDDE检测LVFR的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为94.7%（18/19）、87.1%（27/31）、81.8%（18/22）、96.4%（27/28）和90%（45/50），MCE检测LVFR的相应指标分别为94.7%（18/19）、51.6%（16/31）、54.5%（18/33）、94.1%（16/17）和68%（34/50）。在第1组中，通过LDDE检测发现有收缩储备的节段中86.9%（53/61）功能得到改善，通过MCE检测发现有微血管灌注的节段中65.8%（52/79）功能得到改善。在第2组中，通过LDDE检测发现有收缩储备的节段中78.3%（18/23）功能得到改善，通过MCE检测发现有微血管灌注的节段中25.5%（25/98）功能得到改善。所有未通过MCE检测到灌注的节段均未出现功能恢复。
LDDE是AMI后左心室功能晚期恢复的准确预测指标，而MCE敏感且具有较高的阴性预测值，表明微血管灌注对LVFR至关重要。
