基于参数成像的定量心肌对比超声心动图在预测急性心肌梗死患者直接血管成形术后运动减弱节段功能恢复中的应用价值

[Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients].

作者信息

Serra Viviana, Pérez de Isla Leopoldo, Zamorano José, Almería Carlos, Rodrigo José L, Pérez María, Florit José, Azcona Luis, Hernández Rosa A, Macaya Carlos

机构信息

Instituto Cardiovascular, Departamento de Ecocardiografía, Hospital Clínico San Carlos, Madrid, Spain.

出版信息

Rev Esp Cardiol. 2005 Jun;58(6):649-56.

PMID:15970120

Abstract

INTRODUCTION AND OBJECTIVES

Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments.

PATIENTS AND METHOD

The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images.

RESULTS

The patients' mean age was 62.3+/-14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (beta): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion.

CONCLUSIONS

Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

摘要

引言与目的

心肌对比超声心动图（MCE）有助于预测急性心肌梗死（AMI）后接受直接血管成形术患者运动减弱节段的功能恢复。最近，基于参数成像的定量MCE已被开发用于测量灌注。我们的目的是：a）使用基于参数成像的定量MCE测量接受直接血管成形术患者运动减弱心肌节段的灌注；b）评估这些测量在预测这些节段功能恢复方面的有用性。

患者与方法

研究组包括49例连续接受直接血管成形术的患者。在AMI后2至5天进行MCE和标准超声心动图检查。六个月后，进行额外的标准超声心动图和冠状动脉造影检查。灌注从参数图像离线独立定量。

结果

患者的平均年龄为62.3±14.5岁（39名男性；79.2%）。共检测到约170个运动减弱节段。其中，105个（62.1%）恢复了功能。最能预测功能恢复的定量MCE参数是心肌血流速度（β）：受试者工作特征（ROC）曲线下面积为0.96（95%CI，0.92 - 0.99）。对于截断点为31 dB/s，敏感性为87.62%，特异性为95.31%，阳性预测值为96.8%，阴性预测值为82.43%。这些结果优于使用定性方法评估心肌灌注所获得的结果。