Nagueh S F, Lakkis N M, He Z X, Middleton K J, Killip D, Zoghbi W A, Quiñones M A, Roberts R, Verani M S, Kleiman N S, Spencer W H
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Coll Cardiol. 1998 Jul;32(1):225-9. doi: 10.1016/s0735-1097(98)00220-4.
This study was undertaken to evaluate the ability of myocardial contrast echocardiography (MCE) to guide the targeted delivery of ethanol during nonsurgical septal reduction therapy (NSRT) and to assess the relation between the MCE risk area and infarct size determined by enzymatic and radionuclide methods.
NSRT with intracoronary ethanol is a new promising treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). Proper localization and quantification of the septal infarct before ethanol injection are highly desirable. MCE can provide accurate delineation of the vascular territory of the coronary arteries.
Twenty-nine patients with HOCM and maximal medical therapy underwent NSRT. The left ventricular outflow tract (LVOT) gradient by Doppler echocardiography at baseline was 53 +/- 16 mm Hg (mean +/- SD). Before NSRT, MCE was performed in all patients with intracoronary sonicated albumin (Albunex). Diluted sonicated albumin (Albunex) was selectively injected into the septal perforator arteries during simultaneous transthoracic imaging. Immediately after MCE, ethanol was injected into the same vessel. Plasma total creatine kinase (CK), total CK-MB fraction and CK-MB fraction subforms were measured at baseline and serially for 36 h.
LVOT gradient decreased to 12 +/- 6 mm Hg (p < 0.001) after NSRT. Accurate mapping of the vascular beds of the septal perforators was successfully attained in all patients by MCE. Furthermore, the MCE risk area correlated well with peak CK (r = 0.79, p < 0.001). Six weeks after NSRT, 23 patients underwent myocardial perfusion studies performed with single-photon emission computed tomography (SPECT). Mean SPECT septal perfusion defect size involved 9.5 +/- 6% of the left ventricle and correlated well with MCE area (r = 0.7), with no statistically significant difference between the risk area estimated by MCE and that by SPECT.
Estimation of the size of the septal vascular territory with MCE is accurate, safe and feasible in essentially all patients during NSRT. MCE can delineate the perfusion bed of the septal perforators and can predict the infarct size that follows ethanol injection.
本研究旨在评估心肌对比超声心动图（MCE）在非手术性室间隔心肌消融术（NSRT）期间指导乙醇靶向给药的能力，并评估MCE风险区域与通过酶学和放射性核素方法确定的梗死面积之间的关系。
冠状动脉内注射乙醇的NSRT是肥厚性梗阻性心肌病（HOCM）患者一种新的有前景的治疗方法。乙醇注射前对室间隔梗死进行准确的定位和定量非常必要。MCE可以准确描绘冠状动脉的血管区域。
29例接受最大药物治疗的HOCM患者接受了NSRT。基线时通过多普勒超声心动图测得的左心室流出道（LVOT）梯度为53±16 mmHg（平均值±标准差）。在NSRT前，所有患者均接受冠状动脉内注射超声处理的白蛋白（Albunex）进行MCE检查。在经胸成像的同时，将稀释的超声处理白蛋白（Albunex）选择性注入室间隔穿支动脉。MCE检查后立即将乙醇注入同一血管。在基线时及连续36小时内测定血浆总肌酸激酶（CK）、总CK-MB组分和CK-MB亚组分。
NSRT后LVOT梯度降至12±6 mmHg（p<0.001）。通过MCE成功地在所有患者中准确绘制了室间隔穿支血管床。此外，MCE风险区域与CK峰值密切相关（r = 0.79，p<0.001）。NSRT后六周，23例患者接受了单光子发射计算机断层扫描（SPECT）心肌灌注研究。平均SPECT室间隔灌注缺损面积占左心室的9.5±6%，与MCE面积密切相关（r = 0.7），MCE估计的风险区域与SPECT估计的风险区域之间无统计学显著差异。
在NSRT期间，对基本上所有患者而言，用MCE估计室间隔血管区域的大小准确、安全且可行。MCE可以描绘室间隔穿支的灌注床，并可以预测乙醇注射后的梗死面积。
