本文選題：心肌梗死 + 磁共振成像��； 參考：《中國(guó)循環(huán)雜志》2017年11期

【摘要】：目的:比較磁共振延遲增強(qiáng)顯像(DE-MRI)技術(shù)與小劑量多巴酚丁胺負(fù)荷斑點(diǎn)追蹤超聲(LDDS-STE)技術(shù)評(píng)價(jià)陳舊性心肌梗死患者存活心肌方面的敏感性和特異性。方法:選取30例本院住院陳舊性心肌梗死患者為研究對(duì)象。上述患者接受經(jīng)皮冠狀動(dòng)脈介入治療(PCI)術(shù)前進(jìn)行心臟核磁共振檢查及超聲心動(dòng)圖檢查,LDDS-STE方法分析靜息和負(fù)荷條件下左心室室壁運(yùn)動(dòng)異常節(jié)段短軸徑向應(yīng)變(RS)及應(yīng)變率(RSr),術(shù)后1,3,6個(gè)月復(fù)查超聲心動(dòng)圖,觀察室壁運(yùn)動(dòng)反常節(jié)段運(yùn)動(dòng)是否改善或恢復(fù),以室壁運(yùn)動(dòng)分?jǐn)?shù)改善作為判斷存活心肌的金標(biāo)準(zhǔn)。結(jié)果:30例患者共獲得510個(gè)左心室可分析節(jié)段,超聲心動(dòng)圖判定室壁運(yùn)動(dòng)異常節(jié)段201個(gè)。與金標(biāo)準(zhǔn)比較,靜息狀態(tài)下左心室徑向應(yīng)變(RS_(rest))預(yù)測(cè)陳舊性心肌梗死患者存活心肌受試者工作特征(ROC)曲線下面積為0.636,敏感性為60.0%,特異性為60.5%;小劑量多巴酚丁胺負(fù)荷條件下左心室徑向應(yīng)變(RS_(LDDS))預(yù)測(cè)存活心肌ROC曲線下面積0.806,敏感性和特異性分別為79.1%及82.7%。靜息狀態(tài)下左心室徑向應(yīng)變率(RSr_(rest))預(yù)測(cè)陳舊性心肌梗死患者存活心肌敏感性為60.0%,特異性為60.5%,ROC曲線下面積0.646;小劑量多巴酚丁胺負(fù)荷條件下左心室徑向應(yīng)變率(RSr_(LDDS))預(yù)測(cè)存活心肌敏感性和特異性較靜息狀態(tài)下明顯提高,分別為80.0%及83.7%,ROC曲線下面積0.808。DE-MRI技術(shù)預(yù)測(cè)存活心肌的敏感性和特異性分別為90.8%和87.1%,準(zhǔn)確性89.5%,ROC曲線下面積為0.901。結(jié)論:DE-MRI與LDDS-STE方法均能準(zhǔn)確識(shí)別梗死后存活心肌,但DE-MRI方法檢測(cè)存活心肌的價(jià)值稍高于LDDS-STE,且準(zhǔn)確率及重復(fù)性高,耗時(shí)短,為臨床預(yù)測(cè)陳舊性心肌梗死患者PCI術(shù)的療效及治療策略的選擇提供重要依據(jù)。
[Abstract]:Objective: to compare the sensitivity and specificity of delayed enhanced magnetic resonance imaging (DE-MRI) and low dose dobutamine stress spot tracing ultrasound (LDDS-STE) in evaluating viable myocardium in patients with old myocardial infarction. Methods: 30 old myocardial infarction patients in our hospital were selected. Cardiac MRI and echocardiography before percutaneous coronary intervention (PCI) and LDDS-STE were used to analyze the left ventricular wall motion abnormal segmental short axis radial strain (RS) under resting and loading conditions. The rate of variability (RSr), echocardiography was reexamined at 1 ~ 3 and 6 months postoperatively. Whether abnormal segmental motion of ventricular wall motion was improved or recovered was observed. The improvement of ventricular wall motion score was taken as the gold standard to judge the viable myocardium. Results 510 segments of the left ventricle were obtained from 30 patients and 201 segments of abnormal ventricular wall motion were determined by echocardiography. Compared with the gold standard, The radial strain of left ventricle (RS_ (rest) was used to predict the area under the operating characteristic curve (ROC) of surviving myocardial infarction patients in resting state was 0.636, the sensitivity was 60.010 and the specificity was 60.5.The left ventricular diameter was predicted under low dose dobutamine loading. The area under the ROC curve was 0.806, the sensitivity and specificity were 79.1% and 82.7%, respectively. In resting state, the radial strain rate of left ventricle (RSR _ (rest) was used to predict the survival myocardium of patients with old myocardial infarction. The sensitivity and specificity of the left ventricular radial strain rate (RSR _ (rest) were 60. 0 and 0. 646 under the ROC curve and 0. 646 under low dose dobutamine loading, respectively, and the left ventricular radial strain rate (RSR _ (LDDS) was predicted under low dose dobutamine loading. The sensitivity and specificity of active myocardium were significantly higher than those in resting state. The sensitivity and specificity of 0.808.DE-MRI in predicting viable myocardium were 90.8% and 87.1%, respectively. The accuracy was 89.5and the area under the ROC curve was 0.901.The area under the ROC curve was 0.808.DE-MRI, and the sensitivity and specificity were 90.8% and 87.1%, respectively. Conclusion both the WDE-MRI and LDDS-STE methods can accurately identify viable myocardium after infarction, but the value of DE-MRI in detecting viable myocardium is slightly higher than that of LDDS-STE, and the accuracy and repeatability are high, and the time consuming is short. To provide important basis for clinical prediction of the effect of PCI and the choice of treatment strategy in patients with old myocardial infarction.
【作者單位】： 徐州醫(yī)科大學(xué)附屬醫(yī)院心內(nèi)科;徐州醫(yī)科大學(xué)附屬醫(yī)院心血管病研究所;徐州醫(yī)科大學(xué)附屬醫(yī)院放射科;
【分類號(hào)】：R542.22

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