动脉瘤性蛛网膜下腔出血后的实时心肌灌注对比超声心动图与局部室壁运动异常。临床文章。

Real-time myocardial perfusion contrast echocardiography and regional wall motion abnormalities after aneurysmal subarachnoid hemorrhage. Clinical article.

作者信息

Abdelmoneim Sahar S, Wijdicks Eelco F M, Lee Vivien H, Daugherty Wilson P, Bernier Mathieu, Oh Jae K, Pellikka Patricia A, Mulvagh Sharon L

机构信息

Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Neurosurg. 2009 Nov;111(5):1023-8. doi: 10.3171/2009.3.JNS081723.

DOI:10.3171/2009.3.JNS081723

PMID:19392602

Abstract

OBJECT

The pathophysiology of myocardial dysfunction after subarachnoid hemorrhage (SAH) remains unclear. Using myocardial real-time perfusion contrast echocardiography (RTP-CE), the authors evaluated microvascular function in patients with acute SAH.

METHODS

Over a 15-month period, 10 patients with acute SAH and evidence of cardiac dysfunction were prospectively enrolled. The authors performed RTP-CE within 48 hours of SAH diagnosis. Wall motion and myocardial perfusion were evaluated in 16 left ventricle segments. Qualitative and quantitative RTP-CE analyses were conducted to compare patients with and without regional wall motion abnormalities (RWMAs). Follow-up RTP-CE at a mean of 53.7 +/- 43 days was undertaken in patients with baseline RWMAs.

RESULTS

Ten patients with SAH and evidence of cardiac dysfunction were prospectively enrolled. There were 3 men and 7 women whose mean age was 63.5 +/- 10.1 years. The authors documented evidence of RWMAs in 6 patients. Normal perfusion was demonstrated by RTP-CE in all patients at baseline and follow-up, despite the presence of RWMAs. Compared with patients presenting with normal wall motion, in patients with RWMAs there was a trend for higher quantitative RTP-CE parameters, suggesting hyperemia with mean myocardial blood flow velocity (beta, s(-1)) of 1.08 +/- 0.61 (95% CI 0-2.61) compared with 1.62 +/- 0.64 (95% CI 0.94-2.29) and myocardial blood flow (A x beta, dB/s) of 0.99 +/- 0.41 (95% CI 0-2.0) versus 1.63 +/- 0.86 (95% CI 0.72-2.53). Follow-up RTP-CE was feasible in 3 patients with RWMAs. Regional systolic function was restored in those who completed follow-up.

CONCLUSIONS

The authors found that RTP-CE readily evaluates microvascular function in patients with SAH. Wall motion and perfusion dissociation were observed. Quantitative RTP-CE showed a trend for microvascular hyperemia in patients with RWMAs, suggesting that post-SAH myocardial dysfunction could occur in the absence of microvascular dysfunction.

摘要

目的

蛛网膜下腔出血（SAH）后心肌功能障碍的病理生理学仍不清楚。作者使用心肌实时灌注对比超声心动图（RTP-CE）评估急性SAH患者的微血管功能。

方法

在15个月的时间里，前瞻性纳入10例急性SAH且有心脏功能障碍证据的患者。作者在SAH诊断后48小时内进行RTP-CE检查。对16个左心室节段的壁运动和心肌灌注进行评估。进行定性和定量RTP-CE分析，以比较有和没有节段性壁运动异常（RWMA）的患者。对基线存在RWMA的患者进行平均53.7±43天的随访RTP-CE检查。

结果

前瞻性纳入10例SAH且有心脏功能障碍证据的患者。其中男性3例，女性7例，平均年龄63.5±10.1岁。作者记录到6例患者存在RWMA证据。尽管存在RWMA，但在基线和随访时，所有患者的RTP-CE均显示灌注正常。与壁运动正常的患者相比，存在RWMA的患者定量RTP-CE参数有升高趋势，提示充血，平均心肌血流速度（β，s-1）为1.08±0.61（95%CI 0 - 2.61），而壁运动正常患者为1.62±0.64（95%CI 0.94 - 2.29）；心肌血流量（A×β，dB/s）分别为0.99±0.41（95%CI 0 - 2.0）和1.63±0.86（95%CI 0.72 - 2.53）。3例存在RWMA的患者可行随访RTP-CE检查。完成随访的患者节段性收缩功能恢复。