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目的:探讨收缩期后收缩(PSS)在腺苷负荷试验中诊断早期心肌缺血的价值。方法:在11只开胸犬中结扎左冠状动脉前降支(LAD)建立心肌缺血及梗死模型。分别记录基础状态、缺血状态(LAD狭窄60%~70%)、梗死状态(LAD100%闭塞)下的组织多普勒(TDI)图像,并予腺苷负荷试验。结果:非LAD节段:于缺血及梗死状态下收缩期后收缩的应变(εps)较基础状态差异无显著性意义,应用腺苷后较用药前差异无显著性意义。LAD节段:与基础状态比较,缺血状态下其εps有所增加,但差异无统计学意义(P>0.05);梗死状态下与基础状态比较,LAD节段的εps显著增加差异有显著性意义(P<0.01);梗死状态下与缺血状态比较,LAD节段的εps改变差异无显著性意义。应用腺苷前后的比较:基础及梗死状态下应用腺苷前后εps无显著性变化,缺血状态下εps较用药前显著增加差异有显著性意义(P<0.05)。结论:结合腺苷负荷试验,PSS可以早期定量区分缺血心肌与非缺血心肌,作为负荷试验中识别缺血的客观指标。
Objective: To investigate the value of systolic post-systolic (PSS) in diagnosing early myocardial ischemia in adenosine stress test. Methods: Left anterior descending coronary artery (LAD) was ligated in 11 thoracotomy dogs to establish a model of myocardial ischemia and infarction. The basal status, Tissue Doppler (TDI) images under ischemic conditions (60% -70% of LAD stenosis) and infarct state (100% occlusion of LAD) were recorded and subjected to adenosine stress test. Results: The non-LAD segments: there was no significant difference in the contractile strain (εps) between ischemic and infarcted conditions compared with the basal state, and there was no significant difference between before and after administration of adenosine. Compared with the basal state, there was an increase in εps in LAD segment, but the difference was not statistically significant (P> 0.05). Compared with the basal state in infarction, the εps in LAD segment increased significantly (P <0.01). There was no significant difference in the change of εps between LAD segments and ischemic status in infarction. Before and after the application of adenosine comparison: basic and infarction before and after the application of adenosine had no significant change in εps, ischemic state εps than before treatment significantly increased the difference was significant (P <0.05). Conclusion: In combination with adenosine stress test, PSS can quantitatively differentiate ischemic myocardium from non-ischemic myocardium in early quantitatively as an objective indicator to identify ischemia in stress test.