心脏核素显像对经皮室间隔化学消融术治疗肥厚型梗阻性心肌病的评价

Radionuclide imaging in evaluation of left ventricular perfusion and function after percutaneous translumial septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

目的探讨99Tcm甲氧基异丁基异腈(MIBI)心肌灌注显像和平衡法核素心室显像在经皮室间隔化学消融术(PTSMA)治疗肥厚型梗阻性心肌病的应用价值。方法8例肥厚型梗阻性心肌病患者,于PTSMA术前3～6[平均(4±1)]d和术后7～15[平均(10±3)]d分别行99TcmMIBI静息心肌灌注显像和平衡法核素心室显像。计算室间隔和左心室侧壁放射性比值及室间隔缺损范围,左心室射血分数(LVEF)、高峰充盈率(PFR)和室间隔局部EF。结果8例患者术前心肌灌注显像均显示室间隔放射性浓聚。术后心肌灌注显像示7例部分室间隔放射性缺损,其中1例伴左心室下壁放射性缺损;术后室间隔和左心室侧壁放射性比值明显低于术前(0.76±0.14比1.15±0.11,P<0.01),室间隔缺损范围占左室的(6.42±1.29)%;仅1例室间隔放射性计数无明显变化。术后PFR明显高于术前[(2.29±0.24)EDVs比(1.62±0.28)EDVs,P<0.01],室间隔局部EF明显低于术前[(34±9)%比(57±7)%,P<0.01],但LVEF无明显变化。结论心脏核素显像有助于判断PTSMA所致心肌损害和心室功能变化。

Objective To evaluate the clinical value of ~99 Tcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (MPI) and equilibrium radionuclide angiography (ERNA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent percutaneous translumial septal myocardial ablation (PTSMA). Methods Eight patients (5 men, 3 women) with symptomatic HOCM underwent rest ~99 Tcm-MIBI MPI and ERNA before and after PTSMA. The septal-to-lateral counts ratio and the extent of septal perfusion defect of the left ventricle were calculated from MPI. The left ventricular ejection fraction (EF), peak filling rate (PFR) and septal regional EF were measured from ERNA. Results ~99 Tcm-MIBI MPI showed increased septal ~99 Tcm-MIBI uptake before PTSMA in all patients, and septal perfusion defects after PTSMA in 7 patients. The count-activity ratio of the septal-to-lateral wall decreased from 1.15±0.11 to 0.76±0.14 (P<0.01). The defect extent of the left ventricular septum was (6.42±1.29)%. Furthermore, PFR increased significantly from (1.62±0.28) EDV/s before PTSMA to (2.29±0.24) EDV/s after PTSMA (P<0.01). The left ventricular septal regional EF decreased from (57±7)% to (34±9)% (P<0.01). However, left ventricular EF did not change significantly. Conclu-sion MPI and ERNA are useful for the assessment of myocardial pefusion and the change of left ventricular function after PTSMA in patients with HOCM.