• 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院 心血管外科，哈爾濱 150001;

隨著對(duì)急性心肌梗死（AMI）、慢性冠心病及其并發(fā)癥治療的進(jìn)展，導(dǎo)致帶有左心功能不全生存的患者越來(lái)越多，已有研究表明，存活心肌對(duì)AMI后和慢性心力衰竭患者的預(yù)后判斷及臨床決策起到了重要作用。存活心肌是指冠狀動(dòng)脈缺血或缺血再灌注后收縮功能可逆性減低但仍有收縮儲(chǔ)備的心肌，微血管的完整性與心肌的存活性對(duì)應(yīng)。心肌超聲造影（myocardial contrast echocardiography，MCE）能評(píng)估AMI及慢性冠心病患者心肌功能障礙區(qū)域內(nèi)的微血管完整性，從而檢測(cè)存活心肌并預(yù)測(cè)功能障礙區(qū)域再灌注后功能恢復(fù)的可能性，為臨床醫(yī)師的個(gè)體化治療提供有價(jià)值的信息。

引用本文： 徐磊,劉宏宇. 心肌超聲造影評(píng)價(jià)存活心肌的應(yīng)用進(jìn)展. 中國(guó)胸心血管外科臨床雜志, 2012, 19(5): 551-554. doi: 復(fù)制

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7. 　Kaul S， Jayaweera AR. Coronary and myocardial blood volumes：noninvasive tools to assess the coronary microcirculation??Circulation， 1997， 96（3）：719-724.
8. 　Wei K， Jayaweera AR， Firoozan S， et al. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation， 1998， 97 （5）：473-483.
9. 　Galiuto L， Locorotondo G， Paraggio L， et al. Characterization of microvascular and myocardial damage within perfusion defect area at myocardial　contrast echocardiography in the subacute phase of myocardial infarction. Eur Heart J Cardiovasc Imaging， 2012， 13 （2）：174-180.
10. 　Ito H， Tomooka T， Sakai N， et al. Lack of myocardial perfusion immediately after successful thrombolysis：a predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation， 1992， 85 （5）：1699-1705.
11. 　Ohmori K， Cotter B， Leistad E， et al. Assessment of myocardial postreperfusion viability by intravenous contrast echocardiography：analysis of the intensity and texture of opacification. Circulation， 2001， 103 （15）：2021-2027.
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13. 　Olszowska M， Kostkiewicz M， Podolec P， et al. Myocardial viabi-lity detected by myocardial contrast echocardiography—prognostic value in patients after myocardial infarction. Echocardiography， 2010， 27 （4）：430-434.
14. 　Galiuto L， Garramone B， Scara A， et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling. J Am Coll Cardiol， 2008， 51 （5）：552-559.
15. 　Balcells E， Powers ER， Lepper W， et al. Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve. J Am Coll.
16. 　Hayat SA， Senior R. Myocardial contrast echocardiography in ST elevation myocardial infarction：ready for prime time? Eur Heart J， 2008， 29 （3）：299-314.
17. 　申屠偉慧， 鄧又斌， 黃潤(rùn)青， 等. 實(shí)時(shí)心肌造影超聲心動(dòng)圖再充盈參數(shù)評(píng)估心肌梗死后心肌存活性. 中國(guó)超聲醫(yī)學(xué)雜志， 2008， 24 （4）：370-372.
18. 　Hickman M， Janardhanan R， Dwivedi G， et al. Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability：a comparative study with myocardial contrast echocardiography and single photon emission computed tomography. Int J Cardiol， 2007， 114 （1）：139-140.
19. 　Huang WC， Chiou KR， Liu CP， et al. Comparison of real-time contrast echocardiography and low-dose dobutamine stress echocardiography in predicting the left ventricular functional recovery in patients after acute myocardial infarction under different therapeutic intervention. Int J Cardiol， 2005， 104 （1）：81-91.
20. 　Senior R， Swinburn JM. Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine nonresponsive myocardium early after acute myocardial infarction. Am J Cardiol， 2003， 91 （4）：397-402.
21. 　Schinkel AF， Bax JJ， Poldermans D， et al. Hibernating myocardium：diagnosis and patient outcomes. Curr Probl Cardiol， 2007， 32 （7）：375-410.
22. 　Fernandes DR， Tsutsui JM， Bocchi EA， et al. Qualitative and quantitative real time myocardial contrast echocardiography for detecting hibernating myocardium. Echocardiography， 2011， 28 （3）：342-349.
23. 　Tousek P， Penicka M， Tintera J， et al. Identification of hibernating myocardium with myocardial contrast echocardiography：comparison with late gadolinium-enhanced magnetic resonance. Int J Cardiol， 2008， 128 （1）：117-120.
24. 　Chelliah RK， Hickman M， Kinsey C， et al. Myocardial contrast echocardiography versus single photon emission computed tomography for assessment of hibernating myocardium in ischemic cardiomyopathy：preliminary qualitative and quantitative results. J Am Soc Echocardiogr， 2010， 23 （8）：840-847.
25. 　Hickman M， Chelliah R， Burden L， et al. Resting myocardial blood flow， coronary flow reserve， and contractile reserve in hibernating myocardium：implications for using resting myocardial contrast echocardiography vs. dobutamine echocardiography for the detection of hibernating myocardium. Eur J Echocardiogr， 2010， 11 （9）：756-762.
26. 　Korosoglou G， Hansen A， Hoffend J， et al. Comparison of real-time myocardial contrast echocardiography for the assessment of myocardial viability with fluomdeoxyglueose-18 positron emission tomography and dobutamine stress echocardiography. Am J Cardiol， 2004， 94 （5）：570-576.
27. 　Meza MF， Ramee S， Collins T， et al. Knowledge of perfusion and contractile reserve improves the predictive value of recovery of regional myocardial function postrevascularization. A study using the combination of myocardial contrast echocardiography and dobutamine echocardiography. Circulation， 1997， 96 （10）：3459-3465.
28. 　Nelson C， Marwick TH. Clinical decision-making and myocardial viability：current perspectives. Int Med J， 2005， 35 （2）：118-125.
29. 　李東野. 存活心肌檢測(cè)對(duì)冠心病血運(yùn)重建治療決策的影響. 中華臨床醫(yī)師雜志：電子版， 2009， 3 （7）：1094-1099.
30. 　Slart RH， Bax JJ， van Veldhuisen DJ， et al. Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Int J Cardiovasc Imaging， 2006， 22 （1）：63-80.
  1. 1. Cardiol， 2003， 41 （5）：827-833.
  2. 2. 　McManus DD， Chinali M， Saczynski JS， et al. Thirty-year trends in heart failure in patients hospitalized with acute myocardial infarction. Am J Cardiol， 2011， 107 （3）：353-359.
  3. 3. 　Rees G， Bristow JD， Kremkau EL， et al. Influence of aortocoronary bypass surgery on left ventricular performance. N Engl J Med， 1971， 284 （20）：1116-1120.
  4. 4. 　Kloner RA， Bolli R， Marban E， et al. Medical and cellular implications of stunning， hibernation， and preconditioning：an NHLBI workshop.　Circulation， 1998， 97 （18）：1848-1867.
  5. 5. 　Rahimtoola SH. The hibernating myocardium. Am Heart J， 1989， 117 （1）：211-221.
  6. 6. 　Kaufmann BA， Wei K， Lindner JR. Contrast echocardiography. Curr Probl Cardiol， 2007， 32 （2）：51-96.
  7. 7. 　Kaul S， Jayaweera AR. Coronary and myocardial blood volumes：noninvasive tools to assess the coronary microcirculation??Circulation， 1997， 96（3）：719-724.
  8. 8. 　Wei K， Jayaweera AR， Firoozan S， et al. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation， 1998， 97 （5）：473-483.
  9. 9. 　Galiuto L， Locorotondo G， Paraggio L， et al. Characterization of microvascular and myocardial damage within perfusion defect area at myocardial　contrast echocardiography in the subacute phase of myocardial infarction. Eur Heart J Cardiovasc Imaging， 2012， 13 （2）：174-180.
  10. 10. 　Ito H， Tomooka T， Sakai N， et al. Lack of myocardial perfusion immediately after successful thrombolysis：a predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation， 1992， 85 （5）：1699-1705.
  11. 11. 　Ohmori K， Cotter B， Leistad E， et al. Assessment of myocardial postreperfusion viability by intravenous contrast echocardiography：analysis of the intensity and texture of opacification. Circulation， 2001， 103 （15）：2021-2027.
  12. 12. 　Dwivedi G， Janardhanan R， Hayat SA， et al. Prognostic value of myocardial viability detected by myocardial contrast echocardiography early after acute myocardial infarction. J Am Coll Cardiol， 2007， 50 （4）：327-334.
  13. 13. 　Olszowska M， Kostkiewicz M， Podolec P， et al. Myocardial viabi-lity detected by myocardial contrast echocardiography—prognostic value in patients after myocardial infarction. Echocardiography， 2010， 27 （4）：430-434.
  14. 14. 　Galiuto L， Garramone B， Scara A， et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling. J Am Coll Cardiol， 2008， 51 （5）：552-559.
  15. 15. 　Balcells E， Powers ER， Lepper W， et al. Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve. J Am Coll.
  16. 16. 　Hayat SA， Senior R. Myocardial contrast echocardiography in ST elevation myocardial infarction：ready for prime time? Eur Heart J， 2008， 29 （3）：299-314.
  17. 17. 　申屠偉慧， 鄧又斌， 黃潤(rùn)青， 等. 實(shí)時(shí)心肌造影超聲心動(dòng)圖再充盈參數(shù)評(píng)估心肌梗死后心肌存活性. 中國(guó)超聲醫(yī)學(xué)雜志， 2008， 24 （4）：370-372.
  18. 18. 　Hickman M， Janardhanan R， Dwivedi G， et al. Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability：a comparative study with myocardial contrast echocardiography and single photon emission computed tomography. Int J Cardiol， 2007， 114 （1）：139-140.
  19. 19. 　Huang WC， Chiou KR， Liu CP， et al. Comparison of real-time contrast echocardiography and low-dose dobutamine stress echocardiography in predicting the left ventricular functional recovery in patients after acute myocardial infarction under different therapeutic intervention. Int J Cardiol， 2005， 104 （1）：81-91.
  20. 20. 　Senior R， Swinburn JM. Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine nonresponsive myocardium early after acute myocardial infarction. Am J Cardiol， 2003， 91 （4）：397-402.
  21. 21. 　Schinkel AF， Bax JJ， Poldermans D， et al. Hibernating myocardium：diagnosis and patient outcomes. Curr Probl Cardiol， 2007， 32 （7）：375-410.
  22. 22. 　Fernandes DR， Tsutsui JM， Bocchi EA， et al. Qualitative and quantitative real time myocardial contrast echocardiography for detecting hibernating myocardium. Echocardiography， 2011， 28 （3）：342-349.
  23. 23. 　Tousek P， Penicka M， Tintera J， et al. Identification of hibernating myocardium with myocardial contrast echocardiography：comparison with late gadolinium-enhanced magnetic resonance. Int J Cardiol， 2008， 128 （1）：117-120.
  24. 24. 　Chelliah RK， Hickman M， Kinsey C， et al. Myocardial contrast echocardiography versus single photon emission computed tomography for assessment of hibernating myocardium in ischemic cardiomyopathy：preliminary qualitative and quantitative results. J Am Soc Echocardiogr， 2010， 23 （8）：840-847.
  25. 25. 　Hickman M， Chelliah R， Burden L， et al. Resting myocardial blood flow， coronary flow reserve， and contractile reserve in hibernating myocardium：implications for using resting myocardial contrast echocardiography vs. dobutamine echocardiography for the detection of hibernating myocardium. Eur J Echocardiogr， 2010， 11 （9）：756-762.
  26. 26. 　Korosoglou G， Hansen A， Hoffend J， et al. Comparison of real-time myocardial contrast echocardiography for the assessment of myocardial viability with fluomdeoxyglueose-18 positron emission tomography and dobutamine stress echocardiography. Am J Cardiol， 2004， 94 （5）：570-576.
  27. 27. 　Meza MF， Ramee S， Collins T， et al. Knowledge of perfusion and contractile reserve improves the predictive value of recovery of regional myocardial function postrevascularization. A study using the combination of myocardial contrast echocardiography and dobutamine echocardiography. Circulation， 1997， 96 （10）：3459-3465.
  28. 28. 　Nelson C， Marwick TH. Clinical decision-making and myocardial viability：current perspectives. Int Med J， 2005， 35 （2）：118-125.
  29. 29. 　李東野. 存活心肌檢測(cè)對(duì)冠心病血運(yùn)重建治療決策的影響. 中華臨床醫(yī)師雜志：電子版， 2009， 3 （7）：1094-1099.
  30. 30. 　Slart RH， Bax JJ， van Veldhuisen DJ， et al. Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Int J Cardiovasc Imaging， 2006， 22 （1）：63-80.