| Background: Coronary chronic total occlusion(CTO)lesions are common and severe coronary lesions in the clinic,and it is the end stage lesion of coronary heart disease.At present,scholars still hold different views on the treatment of coronary CTO lesions: some experts believe that occlusion of blood vessels should be actively activated to inhibit ventricular remodeling and improve cardiac function.Some experts also analyzed that some patients with coronary artery CTO lesions are seriously affected by the disease.Most of the viable myocardium has been lost.Even if the diseased blood vessels are successfully opened,the postoperative cardiac function has not been significantly improved.For such patients,other more appropriate treatments should be sought.Therefore,in order to optimize the treatment decisions of patients with coronary CTO lesions,the viable myocardium should be actively evaluated clinically.In recent years,myocardial contrast echocardiography(MCE)has gradually entered people's field of vision.It is believed that the viable myocardium can be judged by detecting the perfusion of myocardial microcirculation.But the clinical value of MCE is still controversial.Objective: To explore the clinical research effect and application value of MCE in evaluating viable myocardium in patients with coronary CTO lesions.Methods: From November 2017 to December 2018,in the Department of Cardiology of our hospital,we enrolled 73 patients with coronary angiography was diagnosed as coronary CTO lesions and occlusion of blood vessels was successfully performed.All patients were enrolled in the hospital,followed by general echocardiography,MCE examination,revascularization,and second general echocardiography(3 months after revascularization).The left ventricle "segment segmentation method" recommended by the American Society of Echocardiography was used to finally incorporate 756 myocardial segments according to the test criteria.According to the segmental wall motion scoring method,MCE semi-quantitative method and MCE quantitative method,viable myocardium and non-viable myocardium were respectively determined,and the segmental wall motion score method was used as the "gold standard" for detecting viable myocardium.The MCE semi-quantitative method and MCE quantitative method were compared with the gold standard,and the sensitivity,specificity and accuracy of the viable myocardium were compared between the two methods.To explore the feasibility and clinical value of MCE in evaluating viable myocardium.Results: MCE is safer and has no adverse reactions during and after the examination.Compared with the gold standard,MCE semi-quantitative method to assess the sensitivity,specificity,false positive rate,false negative rate,accuracy,positive predictive value and negative predictive value of viable myocardium were: 73.2%,74.3%,25.7%,26.8%,73.7%,79.9%,66.5%.MCE quantitative assessment of viable myocardium showed that the A,?,and A × ? values of viable myocardium were larger than those of non-survival muscles,and the differences were statistically significant.(Note: A value in MCE quantitative method represents myocardial blood volume;? value represents myocardial blood flow velocity;A × ? value represents myocardial blood flow).MCE quantitative assessment of viable myocardium(A × ? value)sensitivity,specificity,false positive rate,false negative rate,accuracy,positive predictive value,negative predictive value were: 89.3%,71.9%,31.5%,15.8 %,80.2%,83.4%,79.1%.Compared with MCE semi-quantitative method,MCE quantitative method for assessing viable myocardium has higher sensitivity,accuracy and negative predictive value,and lower specificity.Conclusion: In this study,MCE examination is safe and feasible,can relatively accurately detect the blood perfusion of coronary microcirculation,evaluate viable myocardium,and provide reference for the choice of treatment decision and the prognosis of patients with coronary CTO lesions in clinical practice. |
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