Cho Jung Sun, Her Sung-Ho, Youn Ho-Joong, Kim Chan Joon, Park Mahn-Won, Kim Gee Hee, Chung Woo-Baek, Park Chan Seok, Cho Eun-Joo, Kim Mi-Jeong, Jung Hae-Ok, Jeon Hui-Kyung
Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
Echocardiography. 2015 Mar;32(3):475-82. doi: 10.1111/echo.12663. Epub 2014 Jun 28.
Microvascular obstruction becomes more severe with longer duration of ischemia, such as chronic total occlusion (CTO) which used to have collateral flow. In this study, we explored the correlation between parameters measured using quantitative myocardial perfusion contrast echocardiography (MCE) and the angiographic collateral flow grades in patients with CTO. Furthermore, we investigated the usefulness of the parameters of quantitative MCE for the measurement of microvasculature changes after revascularization of CTO lesions.
Between January 2011 and January 2013, 44 patients who had undergone coronary angiography (CAG) due to chest pain and had confirmed CTO lesions were enrolled in this prospective observational study. All patients had baseline MCE within 24 hours after diagnostic CAG. Patients were then assigned to one of two groups: a medical therapy group (Group I, n = 20) or a reperfusion group with percutaneous coronary intervention (PCI) (Group II, n = 24). All patients had follow-up MCE 3 months later.
Consistent with the CAG results in both groups, on baseline MCE, the myocardial blood flow (AI × β) values were higher in Grade III collateral flow than in Grade I or II collateral flow (AI of collateral flow Grade I vs. Grade II vs. Grade III: 2.34 ± 2.65 vs. 2.52 ± 2.67 vs. 3.87 ± 4.57, P = 0.038). The plateau acoustic intensity (AI) and wall-motion score index (WMSI) were significantly improved at the 3-month follow-up after successful reperfusion with PCI (5.75 ± 3.52 before vs. 8.11 ± 6.02 after, P = 0.004) and (1.76 ± 0.83 before vs. 1.43 ± 0.64 after, P ≤ 0.001), respectively. However, the AI and WMSI values were not improved in the medical treatment group, (6.04 ± 4.64 before vs. 6.01 ± 5.52 after, P = 0.966) and (1.61 ± 0.82 before vs. 1.66 ± 0.67 after, P = 0.616), respectively.
MCE is a useful tool for estimating microvascularity in patients with CTO lesions and correlates well with angiographic collateral flow.
随着缺血时间延长，微血管阻塞会变得更加严重，比如既往存在侧支血流的慢性完全闭塞（CTO）病变。在本研究中，我们探讨了使用定量心肌灌注对比超声心动图（MCE）测量的参数与CTO患者血管造影侧支血流分级之间的相关性。此外，我们研究了定量MCE参数在测量CTO病变血运重建后微血管变化方面的实用性。
在2011年1月至2013年1月期间，44例因胸痛接受冠状动脉造影（CAG）并确诊为CTO病变的患者被纳入这项前瞻性观察研究。所有患者在诊断性CAG后24小时内进行了基线MCE检查。然后将患者分为两组之一：药物治疗组（I组，n = 20）或经皮冠状动脉介入治疗（PCI）的再灌注组（II组，n = 24）。所有患者在3个月后进行了随访MCE检查。
与两组的CAG结果一致，在基线MCE时，III级侧支血流的心肌血流量（AI×β）值高于I级或II级侧支血流（I级侧支血流与II级侧支血流与III级侧支血流的AI：2.34±2.65 vs. 2.52±2.67 vs. 3.87±4.57，P = 0.038）。PCI成功再灌注后3个月随访时，平台期声学强度（AI）和壁运动评分指数（WMSI）显著改善（之前为5.75±3.52，之后为8.11±6.02，P = 0.004）和（之前为1.76±0.83，之后为1.43±0.64，P≤0.001）。然而，药物治疗组的AI和WMSI值没有改善，（之前为6.04±4.64，之后为6.01±5.52，P = 0.966）和（之前为1.61±0.82，之后为1.66±0.67，P = 0.616）。
MCE是评估CTO病变患者微血管情况的有用工具，且与血管造影侧支血流相关性良好。
