多巴酚丁胺输注时二尖瓣环射血前期运动速度反应：一种评估心肌存活性的定量方法。

Pre-ejection mitral annular motion velocity responses to dobutamine infusion: A quantitative approach for assessment of myocardial viability.

作者信息

Darahim Khaled, Attia Ihab, Farag Nabil, El-Hammady Walid, Onsy Ahmed

机构信息

Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.

出版信息

J Saudi Heart Assoc. 2014 Jan;26(1):15-22. doi: 10.1016/j.jsha.2013.08.002. Epub 2013 Aug 13.

DOI:10.1016/j.jsha.2013.08.002

PMID:24578596

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3936240/

Abstract

BACKGROUND

Dobutamine stress echocardiography (DSE) is widely used for detection of myocardial viability. The main limitation of DSE is its subjective interpretation. Assessment of mitral annular motion velocities with tissue Doppler imaging is a simple and quantitative measurement.

OBJECTIVE

To determine the relationship between myocardial viability and regional systolic mitral annular motion tissue Doppler velocities responses to dobutamine stress.

METHODS

Our study group included 42 patients with previous myocardial infarction referred for coronary angiography and revascularization. We did dobutamine stress tissue Doppler echocardiography (DSTDE) measuring velocities of pre-ejection wave (pre-Ej) and peak ejection wave (Ej) at rest and during low-dose dobutamine infusion. We did follow up echocardiography after 1 month.

RESULTS

After exclusion of the normokinetic walls, we analyzed 196 walls. Using receiver operator characteristic ROC curves, the optimal cut-off value for viability assessment was an increase of 1.75 cm/s in pre-ejection velocity during DSTDE (area under the curve 0.70, p < 0.001). On the other hand, the optimal cut-off value for viability assessment was an increase of 1.75 cm/s in ejection velocity during DSTDE (area under the curve 0.613, p = 0.01). The sensitivity, specificity, and total accuracy of the DSTSE (pre-Ej) versus the gold standard for detection of myocardial viability were 66.15%, 67.94%, and 67.35%, respectively. The sensitivity, specificity, and total accuracy of the DTSE (Ej) were 56.92%, 64.12%, and 61.43%, respectively. There was a good correlation between the pre-Ej at 5 ug/kg/min dobutamine infusion and the pre-Ej after revascularization (r = 0.64, p = 0.01) while the correlation with the Ej was moderate (r = 0.50, p = 0.01).

CONCLUSION

Viable left ventricular myocardium could be identified easily and quantitatively with pre-ejection mitral annular velocity during dobutamine infusion. The pre-ejection wave during DSTDE showed greater sensitivity and specificity for the prediction of myocardial viability than the ejection wave.

摘要

背景

多巴酚丁胺负荷超声心动图（DSE）广泛用于检测心肌存活情况。DSE的主要局限性在于其主观解读。用组织多普勒成像评估二尖瓣环运动速度是一种简单的定量测量方法。

目的

确定心肌存活与多巴酚丁胺负荷下二尖瓣环区域收缩期运动组织多普勒速度反应之间的关系。

方法

我们的研究组包括42例既往有心肌梗死病史且因冠状动脉造影和血运重建前来就诊的患者。我们进行了多巴酚丁胺负荷组织多普勒超声心动图（DSTDE）检查，测量静息状态下以及低剂量多巴酚丁胺输注过程中的射血前期波（pre-Ej）和射血峰值波（Ej）速度。1个月后我们进行了随访超声心动图检查。

结果

排除正常运动壁后，我们分析了196个室壁。使用受试者工作特征（ROC）曲线，DSTDE期间射血前期速度增加1.75 cm/s是存活评估的最佳截断值（曲线下面积0.70，p < 0.001）。另一方面，DSTDE期间射血速度增加1.75 cm/s是存活评估的最佳截断值（曲线下面积0.613，p = 0.01）。DSTSE（pre-Ej）检测心肌存活情况相对于金标准的敏感性、特异性和总准确性分别为66.15%、67.94%和67.35%。DTSE（Ej）的敏感性、特异性和总准确性分别为56.92%、64.12%和61.43%。多巴酚丁胺输注速度为5 μg/kg/min时的pre-Ej与血运重建后的pre-Ej之间存在良好相关性（r = 0.64，p = 0.01），而与Ej的相关性为中等（r = 0.50，p = 0.01）。