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冬眠心肌的识别:心肌对比超声心动图、静息-再分布铊-201断层扫描及多巴酚丁胺超声心动图的对比准确性

Identification of hibernating myocardium: comparative accuracy of myocardial contrast echocardiography, rest-redistribution thallium-201 tomography and dobutamine echocardiography.

作者信息

Nagueh S F, Vaduganathan P, Ali N, Blaustein A, Verani M S, Winters W L, Zoghbi W A

机构信息

Department of Medicine, Baylor College of Medicine, The Methodist Hospital, Houston, Texas 77030, USA.

出版信息

J Am Coll Cardiol. 1997 Apr;29(5):985-93. doi: 10.1016/s0735-1097(97)00001-6.

Abstract

OBJECTIVES

We sought to evaluate the comparative accuracy of myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 microg/kg body weight per min) dobutamine echocardiography (DE) in identifying myocardial hibernation.

BACKGROUND

Myocardial contrast echocardiography can assess myocardial perfusion and may therefore be useful in predicting myocardial hibernation. However, its accuracy in comparison to myocardial perfusion scintigraphy and to that of high dose DE remains to be investigated.

METHODS

Eighteen patients (aged [+/- SD] 57 +/- 10 years) with stable coronary artery disease and ventricular dysfunction underwent the above three modalities before coronary revascularization. Myocardial contrast echocardiography was achieved with intracoronary Albunex. Rest echocardiographic and Tl-201 studies were repeated > or = 6 weeks after revascularization.

RESULTS

Of 109 revascularized segments with severe dysfunction, 46 (42%) improved. Left ventricular ejection fraction increased from 38 +/- 14% to 45 +/- 13% at follow-up (p = 0.003). Rest Tl-201 uptake and the ratio of peak contrast intensity of dysfunctional to normal segments with MCE were higher (p < 0.01) in segments that recovered function compared with those that did not. Myocardial contrast echocardiography, thallium scintigraphy and any contractile reserve during DE had a similar sensitivity (89% to 91%) with a lower specificity (43% to 66%) for recovery of function. A biphasic response during DE was the most specific (83%) and the least sensitive (68%) (p < 0.01). The best concordance with MCE was Tl-201 (80%, kappa 0.57). Changes in ejection fraction after revascularization related significantly to the number of viable dysfunctional segments by all modalities (r = 0.54 to 0.65).

CONCLUSIONS

In myocardial hibernation, methods evaluating rest perfusion (MCE, Tl-201) or any contractile reserve have a similar high sensitivity but a low specificity for predicting recovery of function. A limited contractile reserve (biphasic response) increases the specificity of DE. Importantly, the three techniques identified all patients who had significant improvement in global ventricular function.

摘要

目的

我们旨在评估心肌对比超声心动图(MCE)、定量静息-再分布铊-201(Tl-201)断层扫描以及低剂量和高剂量(高达每分钟40微克/千克体重)多巴酚丁胺超声心动图(DE)在识别心肌冬眠方面的相对准确性。

背景

心肌对比超声心动图可评估心肌灌注,因此可能有助于预测心肌冬眠。然而,与心肌灌注闪烁扫描和高剂量DE相比,其准确性仍有待研究。

方法

18例患有稳定冠状动脉疾病和心室功能障碍的患者(年龄[±标准差]57±10岁)在冠状动脉血运重建前接受了上述三种检查方法。通过冠状动脉内注射Albunex实现心肌对比超声心动图检查。血运重建后≥6周重复进行静息超声心动图和Tl-201检查。

结果

在109个严重功能障碍的血运重建节段中,46个(42%)功能得到改善。随访时左心室射血分数从38±14%增加到45±13%(p = 0.003)。与未恢复功能的节段相比,恢复功能的节段静息Tl-201摄取以及MCE中功能障碍节段与正常节段的峰值对比强度比值更高(p < 0.01)。心肌对比超声心动图、铊闪烁扫描以及DE期间的任何收缩储备对功能恢复的敏感性相似(89%至91%),但特异性较低(43%至66%)。DE期间的双相反应特异性最高(83%),敏感性最低(68%)(p < 0.01)。与MCE一致性最好的是Tl-201(80%,kappa值为0.57)。血运重建后射血分数的变化与所有检查方法检测到的存活功能障碍节段数量显著相关(r = 0.54至0.65)。

结论

在心肌冬眠中,评估静息灌注(MCE、Tl-201)或任何收缩储备的方法对预测功能恢复具有相似的高敏感性,但特异性较低。有限的收缩储备(双相反应)可提高DE的特异性。重要的是,这三种技术识别出了所有整体心室功能有显著改善的患者

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