[使用超声心动图成像技术在心肌梗死后早期识别缺血和/或存活心肌。两种检查方法的比较：双嘧达莫负荷超声心动图和多巴酚丁胺负荷超声心动图]

[Identification of ischemic and/or viable myocardium in early post-infarction period using echocardiographic imaging technique. Comparison of 2 tests: echo-dipyridamole and echo-dobutamine].

作者信息

Rosselli P, Garfagnini A, Bianchi F, Bollini R, Zigliara A, De Marchi E, Boggiano P

机构信息

Servizio di Cardiologia e Utic, USL 18, Lavagna GE.

出版信息

G Ital Cardiol. 1994 Apr;24(4):417-28.

PMID:8056217

Abstract

AIM OF THE STUDY

To compare two stress tests: Dipyridamole-echocardiography (ECHO-DIP) and Dobutamine-echocardiography (ECHO-DOB) with angiographic data (still "gold standard") in early postinfarction period in order to identify ischemic and/or viable myocardium (considering the echocardiographic follow-up as "gold standard").

METHODS

40 consecutive patients (pts), mean age 56, at their first uncomplicated acute myocardial infarction (AMI) treated with thrombolytic agents were studied. All underwent coronary angiography.

RESULTS

The ECHO-DIP test resulted positive in 17 pts for transient regional asynergy (homozone 13/17; heterozonal positivity 4/17). The mean basal Wall Motion Score Index (WMSI) was 0.46 +/- 0.30 and at asynergy was 0.58 +/- 0.33 (p < 0.001). The ECHO-DOB test resulted positive in 20 pts; mean basal WMSI was 0.42 +/- 0.31 and at asynergy 0.55 +/- 0.35 (p < 0.001). Both tests were positive in 14 pts; the site of regional asynergy was the same in each test. During ECHO-DOB hypercinesia appeared in 27/39 pts (WMSI form basal 0.42 +/- 0.31 to 0.22 +/- 0.21 p < 0.001). Recovery of contractile function seems to identify viable myocardium: viable tissue shows early functional recovery during ECHO-DOB infusion. In 14 pts it remained until the end of the test, and in 12 it was transient, denoting the presence of myocardium "at risk". Remote (3- or 6-month) clinical and echocardiographic follow-up were carried out in all pts (25 undergoing medical therapy and 15 after PTCA or coronary bypass). In 26 pts with hyperkinesia at ECHO-DOB, basal echocardiogram revealed improvement of WMSI from 0.42 +/- 0.31 to 0.32 +/- 0.29 (p < 0.001).

CONCLUSIONS

"Passive" ECHO-stress tests in the early postinfarction period are easy to perform and free of major risks, they allow pts at risk due to residual ischemia to be revealed with a high degree of specificity and sensitivity. The improvement of kinesis during inotropic stimulus of Dobutamine suggests stunned or hibernating myocardium.

摘要

研究目的

比较双嘧达莫超声心动图（ECHO - DIP）和多巴酚丁胺超声心动图（ECHO - DOB）这两种负荷试验与梗死后期早期的血管造影数据（仍为“金标准”），以识别缺血和/或存活心肌（将超声心动图随访视为“金标准”）。

方法

对40例连续患者（平均年龄56岁）进行研究，这些患者首次发生无并发症的急性心肌梗死（AMI）并接受了溶栓治疗。所有患者均接受了冠状动脉造影。

结果

ECHO - DIP试验在17例患者中出现短暂性局部运动不协调阳性（均匀性区域13/17；非均匀性区域阳性4/17）。平均基础壁运动评分指数（WMSI）为0.46±0.30，运动不协调时为0.58±0.33（p<0.001）。ECHO - DOB试验在20例患者中呈阳性；平均基础WMSI为0.42±0.31，运动不协调时为0.55±0.35（p<0.001）。两种试验在14例患者中均为阳性；每次试验中局部运动不协调的部位相同。在ECHO - DOB试验期间，39例患者中有27例出现运动增强（WMSI从基础值0.42±0.31变为0.22±0.21，p<0.001）。收缩功能的恢复似乎可识别存活心肌：在ECHO - DOB输注期间，存活组织显示早期功能恢复。在14例患者中这种情况持续到试验结束，在12例患者中为短暂性，表明存在“危险”心肌。对所有患者进行了远期（3或6个月）临床和超声心动图随访（25例接受药物治疗，15例接受经皮冠状动脉腔内血管成形术或冠状动脉搭桥术后）。在ECHO - DOB试验中出现运动增强的26例患者中，基础超声心动图显示WMSI从0.42±0.31改善至0.32±0.29（p<0.001）。