Ultrasonic tissue characterization with integrated backscatter. Acute myocardial ischemia, reperfusion, and stunned myocardium in patients.
Ultrasonic tissue characterization with integrated backscatter. Acute myocardial ischemia, reperfusion, and stunned myocardium in patients.
复制标题
具有集成反向散射的超声组织表征。
DOI：
10.1161/01.cir.80.3.491
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发表时间：
1989
期刊：
影响因子：
37.8
通讯作者：
Wickline,SA
中科院分区：
文献类型：
--
作者：
Milunski,MR;Mohr,GA;Pérez,JE;Vered,Z;Wear,KA;Gessler,CJ;Sobel,BE;Miller,JG;Wickline,SA
我们先前在实验动物的研究中已经表明，心肌表现出心脏周期依赖性的变化，反映区域心肌收缩性能，并在动脉闭塞后迅速钝化，再灌注后恢复的背向散射积分。为了确定超声组织定征与背向散射积分检测急性心肌梗死和再灌注的临床效用，21例患者（14名男性和7名女性）在最初的24小时内在心脏监护室进行研究（平均时间11.3小时;范围，出现指示急性心肌梗死的症状后3.5-23.8小时），使用常规二维和M-二维超声心动图及背向散射积分分析。从急性梗死区和远离梗死区的正常区域内的几个部位测量每例患者的背向散射积分的周期变化幅度。在症状出现后的前24小时内，所有患者（n = 21）的平均周期变化幅度在正常区域为4.8 +/- 0.5 dB，而在梗死区域为0.8 +/- 0.3 dB（p小于0.05）。在接受两项研究的患者中，15例（平均7.1天;第二项研究的范围为2-31天）接受冠状动脉造影术以确定血管通畅性。在血管记录通畅的患者中（n = 10），从初始到最终研究，梗死区域的周期变化幅度随时间从1.3 +/- 0.6增加到2.5 +/- 0.5 dB（p <0.05）。梗塞相关动脉闭塞的患者（n = 5）没有表现出明显的循环变异恢复（0.3 +/- 0.3-0.6 +/- 0.3 dB）。对标准二维超声心动图图像的盲法分析显示，在相同的时间间隔内，两组室壁增厚均无显著恢复。超声组织定征可迅速检测急性心肌梗死，并可通过在存在严重室壁运动异常的情况下恢复背向散射积分的周期性变化来描述冠状动脉再灌注的潜在有益作用。
We have previously shown in studies of experimental animals that myocardium exhibits a cardiac cycle-dependent variation of integrated backscatter that reflects regional myocardial contractile performance and that is blunted promptly after arterial occlusion and recovers after reperfusion. To define the clinical utility of ultrasonic tissue characterization with integrated backscatter for detection of acute myocardial infarction and reperfusion, 21 patients (14 men and seven women) were studied in the cardiac care unit within the first 24 hours (mean time, 11.3 hours; range, 3.5-23.8 hours) after the onset of symptoms indicative of acute myocardial infarction with conventional two-dimensional and M-mode echocardiography and with analysis of integrated backscatter. The magnitude of cyclic variation of integrated backscatter was measured from several sites within acute infarct regions and normal regions remote from the infarct zone for each patient. The average magnitude of cyclic variation among all patients (n = 21) was 4.8 +/- 0.5 dB in normal regions compared with 0.8 +/- 0.3 dB in infarct regions (p less than 0.05) within the first 24 hours after the onset of symptoms. Among the patients who had two studies, 15 (mean, 7.1 days; range, 2-31 days for second study) underwent coronary arteriography to define vessel patency. In patients with vessels with documented patency (n = 10), the magnitude of cyclic variation in infarct regions increased over time from 1.3 +/- 0.6 to 2.5 +/- 0.5 dB from the initial to final study (p less than 0.05). Patients with occluded infarct-related arteries (n = 5) exhibited no significant recovery of cyclic variation (0.3 +/- 0.3-0.6 +/- 0.3 dB). A blinded analysis of standard two-dimensional echocardiographic images revealed no significant recovery of wall thickening in either group over the same time intervals. Ultrasonic tissue characterization promptly detects acute myocardial infarction and may delineate potential beneficial effects of coronary artery reperfusion manifest by restoration of cyclic variation of integrated backscatter in the presence of severe wall motion abnormalities.