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題 名 | Myocardial Contrast Echocardiography and Dobutamine Echocardiography in Predicting Viable Myocardium=造影性超音波心圖及dobutamine超音波心圖對預測心肌存活性之比較 |
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作 者 | 林少琳; 謝普霖; 劉俊鵬; 孔明河; 姜洪霆; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 14:3 民87.07-09 |
頁 次 | 頁120-130 |
分類號 | 415.3024 |
關鍵詞 | 造影性超音波心圖; Dobutamine超音波心圖; 急性心肌梗塞; 冠狀動脈性心臟病; Contract echocardiography; Dobutamine echocardiography; Acute myocardial infarction; |
語 文 | 英文(English) |
中文摘要 | 背景:心肌的照影性超音波心圖過去曾顯示可有效評估心肌之血流灌注,低劑量dobutamine超音波心圖,已經可以區分收縮異常但仍然存活的(viable)心肌,不過同時使用兩種方法來評估急性心肌梗塞之存活心肌的研究還不是很普遍。 目的:本研究的目的在比較心肌的造影性超音波心圖及低劑量dobutamine超音波心圖,來預測急性心肌梗塞病人6週後區域性(segments)心室收縮功能的恢復情形。 方法:在急性心肌梗塞之後第三到第七天,在左心室血管攝影及冠狀動脈血管攝影後,十八位急性心肌梗塞病人接受造影性超音波心圖。在心肌的造影性超音波心圖檢查之72小時內,也同時做dobutamine超音波心圖,灌流速率分別為5及10μg/Kg/min各五分鐘,在注射前及不同劑量之dobutamine注射後都分別記錄超音波心圖,在6週後再做一次雙面超音波心圖。在6週之超音波心圖如有原先收縮不正常的segments有恢復收縮現象時,表示這些segments仍存活。十八位病人中的四位(22.2%)自分析中排除,因為他們在心導管室所記錄的超音波影像品質(兩位)或顯影不足太差(兩位)。十四位病人包含於此研究之中,在224segments中的34個segments(15.2%)由於影像不佳,因此剩下190個segments接受造影性及低劑量dobutamine超音波心圖之研究。對其中64個segments在基礎檢查時顯示不正常的心室壁運動特別加以分析,造影性增強的segments及dobutamine超音波心圖有反應(有增強收縮)的segments,為預估是存活之segments,在6星期後再追蹤同樣segments之運動情形並互相比較。 結果:在6週追蹤之雙面超音波心圖中,64個segments有30個(46.9%)segments恢復了收縮,造影性超音波心圖顯示39個segments有超音波影像增強現象,其中有30個segments(76.9%)在六週後恢復了收縮,而另外25個沒有影像增強之segments,都沒有恢復收縮功能。dobutamine超音波心圖發現26個segments有反應,38個segments沒有反應,在有反應之26個segments中,有23個segments(88.5%)在6週時顯示了功能之恢復。在沒有反應之38個segments中,只有7個segments(18.4%)有功能之恢復。對預測6週後心肌功能恢復之情形而言,造影性超音波心圖之敏感性及特異性分別為100%及73.5%,而dobutamine超音波心圖之敏感性及特異性分別為76.7%及91.1%,而兩種方法有相同之準確性(85.9%及84.4%),兩種檢查方法在敏感性、特異性及準確性之比較均沒有明顯之差異。 結論:造影性超音波心圖可反應微小血管之血流狀況,dobutamine超音波心圖可顯示潛在之收縮功能,對急性心肌梗塞收縮異常區存活性之預測而言,這兩種方法都是很好的預測指棹。 |
英文摘要 | Background. Myocardial contrast echocardiography (MCE) has been applied effectively to assess myocardial perfusion. Low dose dobutamine echocardiography (DE) has been used to identify dyssynergic but viable myocardium. Only limited data have been reported comparing both modalities in assessing viable myocardium in patients with acute myocardial infarction (AMI). Purpose. The purpose of this study was to compare MCE and DE in predicting 6-week functional recovery of regional ventricular function in patients with AMI. Methods. Eighteen patients with AMI underwent MCE with intracoronary injection of sonicated albumin on the 3rd to 7th day post-AMI. DE with infusion rates of 5 and 10 μg/kg/min for 5 minutes in each dosage, respectively, was studied within 72 hours of MCE. Four patients were excluded because of either inadequate image quality (2 cases) or insufficient contrast effect (2 cases). Six weeks later, two-dimensional echocardiography was repeated in all patients. In the fourteen patients who underwent both MCE and DE, 190 myocardial segments were adequately visualized at both studies. Of those, 64 segments showing abnormal wall motion at the baseline study were assessed. The contrast enhanced segments and DE responded (improved contractility) segments were compared with the same segments obtained at the 6-week follow-up study. Results. We found that 30 of 64 (46.9%) segments recovered contractility at the follow-up study. MCE showed contrast enhancement in 39 segments, with 30 of them (76.9%) revealing functional improvement at follow-up. None of the other 25 segments without contrast effect showed recovery of contractility. DE found that 26 segments were responsive and 38 segments were non-responsive. For the DE responsive segments, 23 of 26 (88.5%) segments revealed functional improvement at follow-up. Only 7 of 38 (18.4%) of the non-responded segments showed improved contractility. In identifying the viable myocardial segments, MCE had 100% sensitivity and 73.5% specificity, whereas the DE had 76.7% sensitivity and 91.1% specificity. Similar accuracy (85.9% vs 84.4%) were noted by both modalities, however, there were no significant differences in the comparisons of sensitivity, specificity and accuracy. Conclusions. MCE demonstrating microvasular integrity and DE reflecting contractile reserve are good predictors of viability in post-AMI dysfunctioning segments. |
本系統中英文摘要資訊取自各篇刊載內容。