用硝酸酯-多巴酚丁胺门控心肌显像预测左室功能受损冠心病患者 CABG 后早期疗效

Prognostic value of nitrate-dobutamine ^(99)Tc^m-MIBI SPECT in early stage after CABG in patients with coronary heart disease and left ventricular dysfunction

目的硝酸酯与小剂量多巴酚丁胺结合^(99)Tc^m-甲氧基异丁基异腈(MIBI)显像检测存活心肌,用于评价左室功能受损冠心病患者行冠状动脉旁路移植术(CABG)的价值。方法对38例接受CABG 的患者术前行静息硝酸酯与小剂量多巴酚丁胺^(99)Tc^m-MIBI 心肌显像,术后3个月进行静息心肌显像随访。结果①以左室射血分数(LVEF)术后较静息时的变化,患者被分为2组:A 组19例,术后 LVEF 提高≥5%;B 组19例,术后 LVEF 提高<5%。A 组可见术后 LVEF 提高(P<0.001),左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)明显缩小(P<0.05);B 组术后 LVEF、LVEDV、LVESV 无明显改善(P>0.05)。临床随访中 B 组有3例因心力衰竭再次住院治疗。②以术后 LVEF提高≥5%作为标准,用受试者工作特征(ROC)曲线得到多巴酚丁胺负荷试验过程中 LVEF 提高≥4.5%为预测值,A 组中有10例,B 组中有3例,阳性预测值为52.63%,阴性预测值为94.73%。③多巴酚丁胺负荷试验时 LVEF 与术后 LVEF 有明显相关性(r=0.83,P=0.000);LVEDV、LVESV 与术后 LVEDV、LVESV 有明显相关性(r 分别为0.79和0.88,P 均=O.000)。结论多巴酚丁胺负荷试验 LVEF 提高≥4.5%可作为术后 LVEF 提高的预测指标。

Objective To evaluate the prognostic value of nitrate-dobutamine ^99Tc^m-methoxyisobutylisonitrile （MIBI） SPECT in coronary artery bypass graft （CABG） patients with coronary heart disease and left ventricular （LV） dysfunction. Methods Before CABG,38 patients [ 31 men,7 women; mean age （66.55 ± 7.09） years ] with LV dysfunction [ LV ejection fraction （EF） （ 42.73 ± 12.51 ） % ] underwent rest nitrate-dobutamine enhanced ^99Tc^m-MIBI SPECT. Three months later the rest ^99Tc^m-MIBI SPECT was done. Results ①Basing on post-revascularization improvement in LVEF≥5% defined as significant, patients were divided into 2 groups. In group A LVEF increased significantiy ≥5 % in 19 patients at followup and in group B LVEF increased 〈5% in 19 patients. After CABG, LVEF in group A increased（ P 〈 0. 001 ）, end-diastolic volume （EDV） and end-systolic volume （ESV） decreased significantly （ P 〈 0.05 ） ; but LVEF, LVEDV, LVESV had no change in group B. Three patients had refractory heart failure in group B at follow-up. ②According to receiver operating characteristic （ROC） curve analysis, an increase in LVEF≥4.5% during dobutamine was the optimal cutoff value for predicting a significant post-revascularization improvement, with positive predictive value 52.63% , negative predictive value 94.73%.③A significant correlation was found between dobutamine and post-revascularization LVEF （ r = 0.83, P=0.000 ）. The increase in LVEF during dobutamine was a good predictor of an improvement after revascularization. Conclusion An increase in LVEF≥4. 5% during nitrate-dobutamine 99Tcm-MIBI SPECT is the optimal cutoff value for predicting a significant post-revascularization improvement.