Evaluation Of Myocardial Viability In Coronary Heart Disease Patients With Myocardial Infarction By Myocardial Contrast Echocardiography Combined With Adenosine Stress

Objective:To evaluate the clinical value of myocardial contrast echocardiography(MCE)combined with adenosine stress in the detection of viable myocardium in patients with myocardial infarction..Methods:From January 2016 to December 2017,Forty-five patients with coronary heart disease who were diagnosed as myocardial infarction and who underwent coronary revascularization according to electrocardiogram,myocardial enzymology and coronary angiography were enrolled,including 26 males and 19 females.The mean age was 55 ± 15 years,and LVEF was 41 ± 13(%).First,the conventional echocardiographic examination was performed at rest.The results were analyzed by the American Society of Echocardiography's recommended wall segmentation method,and the left ventricular wall was divided into 16 segments.The wall motion is divided into four types: 1 point for normal wall motion,2 points for motion reduction,3 points for no motion on the wall,and 4 points for contradictory movement on the wall.Routine cardiac color Doppler ultrasonography showed a total of 336 segments of left ventricular wall segmental dysplasia in these patients.24 hours before the revascularization of myocardial angiography,Observation of myocardial microcirculation contrast agent filling and enhancement degree in the regional ventricular wall with abnormal motion at resting state or intravenous injection of adenosine finished.Myocardial viability was analyzed by MCE myocardial contrast score(MCS)of 2 to 3 points,adenosine stress(MCS)2 or a contrast intensity improvement of 1 or more points than that at rest.Three months after revascularization,echocardiography was performed and compared with preoperative comparisons.Improvement of ventricular wall motion ?1 point was used as a criterion for judging the existence of viable myocardium.Results:(1)After three months of coronary revascularization,238 improved segments of the myocardial wall motion were viable segments,and 98 segments with no improvement were non-viable.(2)The retrospective analysis showed that in the 196 segments of MCE evaluated as viable myocardium at rest,there were 174 postoperative motor improvement segments,and 22 segments were not improved.In the resting state,MCE was evaluated as 140 segments of non-viable myocardium,64 segments were improved for postoperative movement,and 76 segments were not improved.(3)There were 235 viable myocardium segments evaluated by load MCE,225 postoperative movement improvement segments,and 10 segments were not improved.Among the 101 non-viable myocardium segments evaluated by load MCE,there were 13 improved segments and 88 non-improved segments.The sensitivity,specificity,and accuracy rate of resting state MCE in judging viable myocardium were 73.11%,77.55%,and 74.1%,respectively.The sensitivity,specificity,and accuracy of stress MCE in evaluating viable myocardium were 94.53%,89.79%,and 93.15%,respectively.Conclusions:Myocardial contrast-enhanced ultrasonography can accurately distinguish viable myocardium and non-viable myocardium by combining adenosine stress echocardiography.The sensitivity of myocardial viability diagnosis is 94.53%,the specificity is 89.79%,and the accuracy rate is 93.15%.MCE combined with adenosine stress could accurately,conveniently and visually evaluate viable myocardium,which is of great help and guidance value for the establishment of clinical treatment plan for coronary heart disease patients and observation of curative effect after coronary revascularization.