| Objective:Viable myocardium after myocardial infarction is the base of coronary heart disease revascularization,clinical work is currently in urgent need for a simple, safe and economical method to evaluate myocardial viability,the paper discuss the the efficacy and safety of low dose dobutamine stress myocardial contrast echocardiography to myocardial viability after myocardial infarction.Methods:30 cases had a clear past history of myocardial infarction(excluding those with acute myocardial infarction)and confirmed by coronary angiography at least one major coronary occlusion,use myocardial contrast echocardiography(MCE) and low-dose dobutamine stress myocardial contrast echocardiography to evaluate the viable myocardium.First in the resting state of the downlink MCE,check the left side in patients with supine,apical four-chamber and two chamber view observation, sampling covering the entire left ventricle,the division of law in paragraph 16 of the subjects to carry out sub-apical section,MCE using harmonic frequency of 1.8-3.6MHz Power Doppler mode,according to the ratio of 1:4 in the way of end-systolic triggering extract images,ultrasound contrast agent SF6 concentration of 1.18mg/ml,the use of hand after the earthquake in order to trace peripheral venous infusion pump continuous infusion of 2 minutes(1ml/min),MCE results of myocardial perfusion using semi-quantitative assessment;0 for non-imaging effect, 0.5 for partial or non-uniform imaging role,1 for the role of complete and homogeneous enhancement.MCE segmental infarction defined role for the enhancement≤0.5 points,myocardial viability for developing the role of≥0.5 points.Infusion dose of dobutamine stress were 5,10,20μg / kg / min,each 3 minutes,blood pressure changes in heart rate observed in the loading dose to achieve line again after MCE.And PET as a gold standard to evaluate their sensitivity and specificity.Results:(1) Resting and low dose dobutamine stress MCE have no serious adverse reactions and arrhythmic events.Before and after dobutamine stress the heart rate,blood pressure have statistical significance differences,shows excellent safety.(2)Resting and low dose dobutamine stress MCE with coronary angiography as the standard have good correlation in evaluating myocardial infarction position, accord with coronary angiography resting MCE rate 95.12%,low dose dobutamine stress MCE rate 92.68%(p> 0.05).(3) Resting MCE and after low dose dobutamine stress MCE have evaluated 360 segments respectively,resting MCE score 1,0.5,0,respectively 264,22,74 segments after dobutamine stress MCE score 1,0.5,0,respectively 286,30,44 segments have statistically significant difference(p <0.05).(4) With PET as a gold standard,resting MCE sensitivity 38.10%and specificity 88.89%,positive predictive value 72.73%,negative predictive value 64.86%,accuracy66.67%.Kappa0.285.(5) With PET as the gold standard,low dose dobutamine stress MCE sensitivity 86.21%and specificity 88.89%,positive predictive value 83.33%,negative predictive value 90.91%,accuracy87.84%Kappa 0.746.Conclusion:(1) Resting and low dose dobutamine stress MCE have good safety.(2) Resting and low dose dobutamine stress MCE have better positions related to coronary angiography myocardial infarction.(3) Compared with resting MCE,MCE after low dose dobutamine stress on myocardial viability after myocardial infarction can be judged more accurately.(4) PET as a gold standard,low dose dobutamine stress MCE has a high sensitivity and specificity and has a cheap,convenient,non-invasive characteristics of the evaluation are segmental infarction myocardial memory live a better way,it is worth to be promoted.
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