Olszowska Maria, Tracz Wiesława, Kostkiewicz Magdalena, Hlawaty Marta, Podolec Piotr, Przewłocki Tadeusz
Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie, Klinika Chorób Serca i Naczyń Instytutu Kardiologii.
Pol Merkur Lekarski. 2006 Mar;20(117):282-4.
The myocardial perfusion assessment in myocardial infarction is crucial to proper therapeutical decisions and patient's prognosis. The aim of the study to assess the efficacy of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute myocardial infarction compared with 99mTc MIBI SPECT study.
86 patients (mean age 58.4 +/- 11.2) underwent primary percutaneous coronary (PCI) for acute anterior myocardial infarction. TIMI grade flow, myocardial blush grade (TMPG), corrected TIMI frame count (cTFC) and segmental contractility and segmental perfusion were estimated in real time before and immediately after PCI, using injections of intravenous Optison. MCE performed before PCI described the risk area as the sum of segments with the lack of perfusion. A MCE perfusion defect size after PCI < 25% of the MCE perfusion defect size before PCI was used to define myocardial reperfusion. MCE was repeated on the third day after PCI. All patients underwent a rest 99mTc MIBI SPECT study (SPECT) on the third day after PCI.
Based on MCE, 54 patients had reperfusion ("reflow" group) and 32 had non-reperfusion ("no-reflow" group). Patients from the non-reperfusion group showed a higher creatine kinase peak (p = 0.0034), higher kinase-MB (p = 0.0033) and higher troponine level (p = 0.0629), longer time span between the onset of pain and reperfusion (p = 0.003), and worse baseline regional contractile function (p = 0.0022). All angiographic parameters were worse in this group before as well as after PCI: more often TIMI 0 or 1, TMPG 0 or 1 in patients from "no-reflow" group was observed. These patients had higher cTFC than ones from "reflow" group. The agreement between MCE and SPECT for detecting perfusion abnormality was 87%.
MCE facilitated identification of myocardial perfusion abnormalities in patients with acute myocardial infarction, whereas serial MCE facilitated identification of patients with early and late improvement of myocardial perfusion. MCE correlated very well with SPECT images in assessing perfusion defect.
心肌梗死中的心肌灌注评估对于做出正确的治疗决策和患者预后至关重要。本研究旨在评估静脉对比剂超声心动图（MCE）与99mTc MIBI单光子发射计算机断层扫描（SPECT）研究相比，在检测急性心肌梗死患者心肌灌注缺损方面的疗效。
86例患者（平均年龄58.4±11.2岁）因急性前壁心肌梗死接受了直接经皮冠状动脉介入治疗（PCI）。在PCI前和PCI后立即使用静脉注射Optison实时评估心肌梗死溶栓试验（TIMI）血流分级、心肌造影剂增强分级（TMPG）、校正TIMI帧数（cTFC）以及节段性收缩功能和节段性灌注。PCI前进行的MCE将灌注缺乏节段的总和描述为危险区域。PCI后MCE灌注缺损大小<PCI前MCE灌注缺损大小的25%被用于定义心肌再灌注。PCI后第三天重复进行MCE。所有患者在PCI后第三天接受静息99mTc MIBI SPECT研究（SPECT）。
基于MCE，54例患者实现了再灌注（“再灌注”组），32例未实现再灌注（“无再灌注”组）。无再灌注组患者的肌酸激酶峰值更高（p = 0.0034）、肌酸激酶同工酶更高（p = 0.0033）、肌钙蛋白水平更高（p = 0.0629）、疼痛发作至再灌注的时间跨度更长（p = 0.003），且基线区域收缩功能更差（p = 0.0022）。该组患者在PCI前后所有血管造影参数均更差：“无再灌注”组患者更常出现TIMI 0或1级、TMPG 0或1级。这些患者的cTFC高于“再灌注”组患者。MCE与SPECT在检测灌注异常方面的一致性为87%。
MCE有助于识别急性心肌梗死患者的心肌灌注异常，而连续MCE有助于识别心肌灌注早期和晚期改善的患者。在评估灌注缺损方面，MCE与SPECT图像的相关性非常好。
