Barletta Giuseppe, Del Bene Maria Riccarda
Giuseppe Barletta, Maria Riccarda Del Bene, Cardio-Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 50134 Florence, Italy.
World J Cardiol. 2015 Dec 26;7(12):861-74. doi: 10.4330/wjc.v7.i12.861.
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking.
在过去二十年中，我们对冠状动脉综合征的理解已从心外膜冠状动脉阻塞性动脉粥样硬化范式发展到包括冠状动脉微循环的解剖功能异常。目前尚无诊断技术可直接观察冠状动脉微循环，但对该循环进行功能评估是可行的。这是心脏病学领域面临的一项挑战。心肌对比超声心动图（MCE）是数年前超声心动图领域的一项突破，它声称能够检测心肌灌注异常并量化冠状动脉血流。研究表明，定量MCE与血流储备分数相结合，改善了对缺血负荷的定义以及非临界冠状动脉狭窄时侧支循环的相对贡献。MCE分别在心肌梗死内部和周围识别出无复流和低血流情况，并通过适当干预预测了顿抑心肌的潜在功能恢复。在微血管储备和心绞痛患者的微血管功能障碍方面，MCE表现出与正电子发射断层扫描相当的诊断性能。总体而言，MCE在日常临床实践中改善了对缺血性心脏病的超声心动图评估，但尚未获得监管机构的批准。
