Yang Lixia, Xia Chunmei, Mu Yuming, Guan Lina, Wang Chunmei, Tang Qi, Verocai Flavia Gomes, Fonseca Lea Mirian Barbosa da, Shih Ming Chi
Department of Image Center, Shanghai Xuhui Central Hospital, Shanghai, China.
Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Echocardiography. 2016 Mar;33(3):421-30. doi: 10.1111/echo.13061. Epub 2015 Sep 28.
Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (β), flow indexes (MBF, A × β), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The β- and A × β-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower β- and lower A × β-reserve than patients without adverse cardiac events. In the former group, the CFR was ≥ 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters β-reserve and CFR combined might predict cardiac events on the follow-up.
实时心肌造影超声心动图（RTMCE）是一种经济高效且简单的定量冠状动脉血流储备（CFR）的方法。我们旨在确定RTMCE在预测经皮冠状动脉介入治疗（PCI）后心脏事件方面的价值。我们研究了36例接受PCI的急性冠状动脉综合征（ACS）患者的心肌血容量（A）、速度（β）、血流指数（MBF，A×β）和血管扩张储备（负荷与静息比值）。计算了每位患者的CFR（负荷时MBF/静息时MBF）。灌注评分用于MCE的视觉解读以及与TIMI血流分级的相关性分析。在定性RTMCE评估中，PCI术后的视觉灌注评分高于PCI术前（Z = -7.26，P < 0.01）。在PCI术后TIMI血流分级为3级的271条动脉中，72条（36%）未达到视觉灌注评分1。与PCI术前值相比，阻塞动脉供血的异常节段的β储备和A×β储备在PCI术后增加（P < 0.01）。发生不良心脏事件的患者的β储备和A×β储备显著低于未发生不良心脏事件的患者。在前一组中，PCI术前和术后的CFR均≥1.5。通过RTMCE估计CFR可以量化接受PCI的ACS患者的心肌灌注。参数β储备和CFR联合起来可能预测随访中的心脏事件。
