Wada Hiroshi, Yasu Takanori, Sakakura Kenichi, Hayakawa Yuki, Ishida Takeshi, Kobayashi Nobuhiko, Kubo Norifumi, Ako Junya, Momomura Shin-ichi
First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, Saitama, 330-8503, Japan.
Heart Vessels. 2014 May;29(3):308-12. doi: 10.1007/s00380-013-0363-9. Epub 2013 May 18.
Although detecting left ventricular thrombus in anterior myocardial infarction is important for the prevention of embolic events, imaging of apical thrombus is often difficult using conventional echocardiography. We examined whether contrast echocardiography improves sensitivity and specificity in detecting thrombus in the left ventricle in comparison with conventional echocardiography alone in patients with anterior myocardial infarction. Participants in this single-center prospective study comprised 392 patients with anterior myocardial infarction admitted between 2000 and 2006. After conventional echocardiography, all patients underwent contrast echocardiography (left ventricular opacification and myocardial contrast echocardiography) during intravenous drip infusion of contrast media at rest. Left ventricular thrombus was diagnosed based on left ventriculography or multidetector-row computed tomography (MDCT). Mural left ventricular thrombus was confirmed by left ventriculography and/or MDCT in 32 of 393 patients (8 %). Sensitivity and specificity of conventional echocardiography alone were 88 % and 96 %, respectively, compared with 100 % each with contrast echocardiography. Among the 32 patients with left ventricular thrombus, 25 patients (78 %) showed no perfusion in the anterior wall on myocardial contrast echocardiography, even with a four-beat interval. In conclusion, contrast echocardiography offers a clinically feasible and useful method for noninvasively evaluating left ventricular thrombus in anterior myocardial infarction.
尽管检测前壁心肌梗死患者的左心室血栓对于预防栓塞事件很重要,但使用传统超声心动图对心尖部血栓进行成像往往很困难。我们研究了与仅使用传统超声心动图相比,对比增强超声心动图在检测前壁心肌梗死患者左心室血栓时是否能提高敏感性和特异性。这项单中心前瞻性研究的参与者包括2000年至2006年间收治的392例前壁心肌梗死患者。在进行传统超声心动图检查后,所有患者在静息状态下静脉滴注造影剂时均接受了对比增强超声心动图检查(左心室造影和心肌对比增强超声心动图)。左心室血栓根据左心室造影或多排螺旋计算机断层扫描(MDCT)进行诊断。393例患者中有32例(8%)经左心室造影和/或MDCT证实存在左心室壁血栓。单独使用传统超声心动图的敏感性和特异性分别为88%和96%,而对比增强超声心动图的敏感性和特异性均为100%。在32例左心室血栓患者中,25例(78%)即使在四搏间期的心肌对比增强超声心动图检查中,前壁也无灌注。总之,对比增强超声心动图为无创评估前壁心肌梗死患者的左心室血栓提供了一种临床可行且有用的方法。