低剂量多巴酚丁胺经食管超声心动图和氟-18氟脱氧葡萄糖正电子发射断层扫描对成功血运重建后左心室局部功能恢复的预测价值。

Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization.

作者信息

Baer F M, Voth E, Deutsch H J, Schneider C A, Horst M, de Vivie E R, Schicha H, Erdmann E, Sechtem U

机构信息

Klinik III für Innere Medizin, Universitat zu Köln, Cologne, Germany.

出版信息

J Am Coll Cardiol. 1996 Jul;28(1):60-9. doi: 10.1016/0735-1097(96)00106-4.

DOI:10.1016/0735-1097(96)00106-4

PMID:8752795

Abstract

OBJECTIVES

This study was designed to assess the predictive value of myocardial viability diagnosed by dobutamine transesophageal echocardiography and fluorine (F)-18 fluorodeoxyglucose positron emission tomography for left ventricular functional recovery after revascularization in patients with chronic left ventricular dysfunction.

BACKGROUND

The identification of akinetic but viable myocardium is of particular importance for the selection of patients with a compromised left ventricle who will benefit from coronary revascularization.

METHODS

Multiplane rest and dobutamine transesophageal echocardiography (dobutamine, 5 and 10 microg/min per kg) studies and F-18 fluorodeoxyglucose positron emission tomographic studies at rest were performed in 2 patients with 1) previous myocardial infarction and regional akinesia, 2) a stenosed infarct-related coronary artery, and 3) a patent infarct-related vessel after revascularization. A basally akinetic segment was considered viable by transesophageal echocardiography if dobutamine-induced contractile reserve could be observed. Viability by positron emission tomography was defined as F-18 fluorodeoxyglucose uptake > or = 50% of the maximal uptake in a region with normal wall motion. Recovery of regional left ventricular function 4 to 6 months after revascularization was diagnosed by transesophageal echocardiography if > or = 50% of segments akinetic at baseline had improved wall thickening.

RESULTS

Dobutamine transesophageal echocardiography identified viable infarct regions in 25 (59%) of 42 patients, and F-18 fluorodeoxyglucose positron emission tomography in 30 (71%) of 42 patients, yielding diagnostic agreement in 86% of patients. Sensitivity and specificity for prediction of left ventricular functional recovery in individual patients was 92% and 88%, respectively, for dobutamine transesophageal echocardiography versus 96% and 69% for F-18 fluorodeoxyglucose positron emission tomography. Segments remaining akinetic after revascularization had a significantly lower (p < 0.001) F-18 fluorodeoxyglucose uptake (48 +/- 15%) than that (73 +/- 15%) of segments with recovery of regional left ventricular function.

CONCLUSIONS

Both dobutamine transesophageal echocardiography and F-18 fluorodeoxyglucose positron emission tomography were highly sensitive in predicting functional recovery of chronically kinetic or dyskinetic myocardium after successful revascularization. Thus, dobutamine transesophageal echocardiography is a clinically valuable alternative to F-18 fluorodeoxyglucose positron emission tomography for assessing residual viability and predicting functional recovery after revascularization.

摘要

目的

本研究旨在评估多巴酚丁胺经食管超声心动图及氟（F）-18氟脱氧葡萄糖正电子发射断层扫描诊断的心肌存活性对慢性左心室功能障碍患者血运重建后左心室功能恢复的预测价值。

背景

识别运动减弱但存活的心肌对于选择左心室功能受损且将从冠状动脉血运重建中获益的患者尤为重要。

方法

对2例患者进行了多平面静息及多巴酚丁胺经食管超声心动图检查（多巴酚丁胺，每千克体重5和10微克/分钟）以及静息状态下的F-18氟脱氧葡萄糖正电子发射断层扫描检查，这些患者具备以下情况：1）既往心肌梗死及节段性运动减弱；2）梗死相关冠状动脉狭窄；3）血运重建后梗死相关血管通畅。如果经食管超声心动图可观察到多巴酚丁胺诱导的收缩储备，则基础运动减弱节段被视为存活。正电子发射断层扫描的存活定义为F-18氟脱氧葡萄糖摄取量≥正常室壁运动区域最大摄取量的50%。如果基线时运动减弱的节段中≥50%的节段室壁增厚有所改善，则通过经食管超声心动图诊断血运重建后4至6个月区域左心室功能恢复。

结果

多巴酚丁胺经食管超声心动图在42例患者中的25例（59%）识别出存活的梗死区域，F-18氟脱氧葡萄糖正电子发射断层扫描在42例患者中的30例（71%）识别出存活的梗死区域，86%的患者诊断结果一致。多巴酚丁胺经食管超声心动图预测个体患者左心室功能恢复的敏感性和特异性分别为92%和88%，而F-18氟脱氧葡萄糖正电子发射断层扫描的敏感性和特异性分别为96%和69%。血运重建后仍运动减弱的节段F-18氟脱氧葡萄糖摄取量（48±15%）显著低于（p<0.001）区域左心室功能恢复节段的摄取量（73±15%）。