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目的评价实时心肌声学造影(RT-MCE)在心脏再同步化治疗(CRT)中的临床应用价值。方法对11例冠心病患者行RT-MCE、组织多普勒和应变/应变率成像检查。分析采用PhilipsQ-Lab7.0工作站。以冠状动脉造影或冠状动脉CT显像结果为标准,分为正常组(无狭窄)、轻度狭窄组(狭窄<70%)和重度狭窄组(狭窄≥70%)。剔除2例冠状动脉3支血管均为重度狭窄者,对余下9例患者的RT-MCE结果进行亚组分析,以每例患者心肌血流量(MBF)正常的心肌节段为参照,对其余节段MBF进行标化后分为MBF正常组、MBF轻度降低组和MBF重度降低组(标化值分别为≥0.8、<0.8且≥0.3、<0.3),再进行各项超声参数分析。结果冠状动脉重度狭窄组的组织多普勒S峰值、应变S峰值、应变率Ssys、Smax和MBF较正常组降低(P<0.05),PSI延长。MBF降低组应变S达峰时间、应变率Ssys达峰时间、Smax达峰时间和E达峰时间较正常组延长(P<0.05),而且应变率Ssys达峰时间的延长程度随心肌灌注的降低程度而增加(P<0.05)。结论心肌血流灌注是否正常影响心脏同步性。在CRT植入之前行RT-MCE评价心肌灌注,更有助于判断存活心肌。
Objective To evaluate the clinical value of real-time myocardial contrast echocardiography (RT-MCE) in cardiac resynchronization therapy (CRT). Methods 11 cases of coronary heart disease patients underwent RT-MCE, Tissue Doppler and strain / strain rate imaging examination. Analysis using PhilipsQ-Lab7.0 workstation. The results of coronary angiography or coronary CT imaging as the standard, divided into normal group (no stenosis), mild stenosis group (stenosis <70%) and severe stenosis group (stenosis ≥ 70%). The results of RT-MCE in the remaining 9 patients were subgroup analyzed. The myocardial segments with normal myocardial flow (MBF) in each patient were taken as the reference, The normalized MBF was divided into two groups: normal control group, mild MBF reduction group and severe MBF reduction group (standardized values were ≥0.8, <0.8 and ≥0.3, <0.3, respectively). Results The tissue Doppler S peak, strain S peak, strain rate Ssys, Smax and MBF in severe coronary artery stenosis group were lower than those in normal group (P <0.05), PSI was prolonged. MBF decreased the peak time of strain S, the peak time of strain rate Ssys, Smax peak time and peak time of E were longer than those of normal group (P <0.05), and the prolongation of peak strain time of Ssys was decreased with myocardial perfusion Degree increased (P <0.05). Conclusions Cardiac perfusion is normal or not affecting cardiac synchrony. RT-MCE before CRT implantation for myocardial perfusion, but also help to determine the survival of myocardium.