【作者】 Cyprien MBA MBA（恩巴）；

【导师】 邓又斌；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2011， 博士

【摘要】 目的：探讨大剂量多巴酚丁胺负荷试验结合二维应变成像技术早期诊断冠心病的价值。方法：对临床可疑的冠心病患者28例,进行大剂量多巴酚丁胺负荷试验,分别在静息状态及各级负荷状态下观察室壁运动情况、测定左室各心肌节段心内膜下心肌的纵向收缩期峰值应变,比较大剂量多巴酚丁胺负荷试验目测法及大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性和特异性；计算正常组、冠心病组缺血节段和非缺血节段的纵向收缩期峰值应变平均值并进行组内及组间比较,利用受试者操作特征曲线下面积评价纵向收缩期峰值应变预测缺血心肌的敏感性和特异性。结果：冠心病组多巴酚丁胺剂量为40μg·Kg-1·min-1时目测法检出室壁运动异常6例(共20个节段),计算纵向收缩期峰值应变以后,检测缺血心肌15例(共148节段)；冠心病组大多数缺血节段纵向收缩期峰值应变较正常组及非缺血节段相同负荷状态明显减低(P<0.05),大剂量多巴酚丁胺负荷试验目测法和大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性分别为35.3%和88.2%(P<0.01)、特异性分别为100%和100%(P>0.05)和准确度分别为60.7%和92.8%(P<0.01)。多巴酚丁胺剂量为40μg·Kg-1·min-1时纵向收缩期峰值应变绝对值<14.97为截断值,预测缺血心肌节段的敏感性和特异性分别为83.3%和91.7%。结论：大剂量多巴酚丁胺负荷试验结合二维应变成像技术可以提高检出缺血心肌的敏感性,在大剂量多巴酚丁胺负荷试验状态下,二维应变成像技术能通过测定纵向收缩期峰值应变的变化,定量评价心肌收缩功能的微小改变,发现心肌隐匿性缺血,为临床诊断早期冠心病患者提供了无创性新方法。目的探讨应变率成像结合大剂量多巴酚丁胺负荷试验评价早期冠心病左室心肌舒张功能变化。方法对28例可疑冠心病患者进行大剂量多巴酚丁胺负荷试验,测量舒张早期峰值应变率(SRe)和舒张晚期峰值应变率(SRa),并进行冠心病组和正常对照组的比较。结果冠心病组缺血节段SRe在多巴酚丁胺剂量20μg/(kg.min)时达到最大,与静息状态比较差异有统计学意义；在多巴酚丁胺剂量30和40μg/(kg.min)时降低,与正常对照组、非缺血节段同一负荷状态比较差异有统计学意义。以多巴酚丁胺剂量40μg/ (kg.min)时SRe<1.70为截断值,预测缺血心肌舒张功能异常的敏感性和特异性分别为88.9%和83.3%。结论SRe是反映心肌局部舒张功能变化敏感而特异的指标。更多还原

【Abstract】 Objective To investigate the value of high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging in early diagnosis of coronary artery disease.Methods High-dose dobutamine stress echocardiography was performed in 28 patients with suspected coronary artery disease and all wall motion movement was observed respectively in baseline and at all stress levels; the peak systolic longitudinal strain in subendomyocardial segments of left ventricular were measured to compare the sensitivity and specificity of high-dose dobutamine stress echocardiography visual method and high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging in diagnosis of myocardial ischemia; the peak systolic longitudinal strain average were calculated in all groups and were compared inside and between different groups. Receiver operating characteristic analysis was used to evaluate the peak systolic longitudinal strain predicting the sensitivity and the specificity of myocardial ischemia.Results With 40μg·-Kg-1·min-1 of dobutamine dose, wall motion abnormalities occurred in 6 patients(20 segments) of coronary artery disease group; after calculating the peak systolic longitudinal strain, myocardial ischemia was found in 15 patients (148 segments); the majority of coronary artery disease ischemic segments of peak systolic longitudinal strain were significantly reduced(P<0.05) compared with the non-ischemic segments and control group. High-dose dobutamine stress echocardiography visual method and high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging in diagnostic sensitivity of myocardial ischemia were respectively 35.3 % and 88.2 % (P< 0.01), the specificity were respectively 100 % and 100 % (P>0.05), and the accuracy were respectively 60.7 % and 92.8 % (P< 0.01). When the cutoff absolute value of the peak systolic longitudinal strain was less than 14.97, the sensitivity and specificity in diagnosing of myocardial ischemia were respectively 83.3 % and 91.7 % .Conclusions High-dose dobutamine stress echocardiography combined with two-dimensional strain imaging can increase the sensitivity of myocardial ischemia detection. During high-dose dobutamine stress echocardiography, measuring the peak systolic longitudinal strain by two-dimensional strain imaging could quantitatively evaluate the subendomyocardial systolic function and detect concealed myocardial ischemia by analyzing longitudinal strain. As a new non-invasive method, high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging could be used in early diagnosis of coronary artery disease. Objective To assess the left ventricular diastolic function in early myocardial ischemia by strain rate imaging combined with high-dose dobutamine stress echocardiography.Methods High-dose dobutamine stress echocardiography was performed in 28 patients with suspected coronary artery disease. Early diastolic peak strain rate (SRe) and late diastolic peak strain rate (SRa) were measured. According to the results of coronary angiography myocardial segments were divided in control group and coronary artery disease group.The SRe and SRa average were calculated in all groups and were compared inside and between different groups.Results The maximum SRe in coronary artery disease ischemic group was obtained with dose of 20μg/(kg.min) and SRe decreased significantly with dose of 30 and 40μg/(kg.min), compared with the control group. When the cutoff value of SRe was less than 1.70s-1, the sensitivity and specificity of diastolic function of myocardial ischemia were respectively 88.9 % and 83.3 % .Conclusions SRe is a sensitive and specific indicator in reflecting the reduction of diastolic function in regional myocardial ischemia.更多还原