负荷心肌灌注显像在女性冠状动脉心脏病诊断中的应用价值

Stress myocardial perfusion single photon emission computed tomography imaging in the detection of coronary artery disease in woman

目的评价负荷心肌灌注显像对女性冠状动脉心脏病(冠心病)的诊断价值。方法回顾分析了259例在北京阜外心血管病医院同时进行了负荷心肌灌注显像和冠状动脉造影的女性患者(间隔时间<60d),平均年龄(60±8)岁。其中227例进行了运动试验心肌灌注显像,32例进行了药物负荷心肌灌注显像。结果以冠状动脉管径狭窄≥50%为诊断标准,在接受运动试验心肌灌注显像检查的227例患者中,79例冠状动脉造影显示明显的冠状动脉狭窄病变,其中单支病变33例,双支病变23例,3支病变23例。累及左冠状动脉前降支67支,左冠状动脉回旋支41支,右冠状动脉40支,左主干8支。运动试验心肌灌注显像诊断女性冠心病的灵敏度为63%,特异性为97%,准确性为85%。诊断单支、双支和3支冠状动脉病变患者的灵敏度分别为61%,52%和78%。按运动试验是否达到终止指标,将227例患者分为2组,即运动试验达到终止指标组(n=137)和运动试验未达到终止指标组(n=90)。在运动试验达到终止指标组,运动试验心肌灌注显像诊断女性冠心病的灵敏度为86%。而在运动试验未达终止指标组,诊断灵敏度则为38%。在接受药物负荷心肌灌注显像检查的32例患者中,13例冠状动脉造影显示明显的冠状动脉狭窄病变。药物负荷心肌灌注显像诊断女性冠心病的灵敏度为85%,特异性为84%,准确性为84%。结论负荷心肌灌注显像可以有效诊断女性冠心病,且药物负荷心肌灌注显像更适合于运动耐力受损的老年女性患者。

Objective To assess the diagnostic efficacy of stress myocardial perfusion imaging （MPI） in female coronary artery disease （CAD） patients. Methods Two hundred and fifty-nine consecutive female patients, aged 60 ± 8, underwent stress myocardial perfusion single photon emission computed tomography （SPECT） imaging and coronary angiography with an interval of 〈 60 days. Among them, 227 patients underwent exercise MPI, injected intravenously with ^99mTc-methoxyisobutyl isonitrile （MIBI） 740 -925 MBq when the exercise end point was reached, and 32 patients underwent pharmacologic stress MPI, injected intravenously with persantine or adenosine and then ^99mTc- MIBI. Results Among the 227 patients undergoing exercise MPI 79 had significant coronary artery stenosis with the overall sensitivity and specificity for detecting coronary artery disease of 63% and 97% respectively. According to the exercise heart rate, the 227 patients were divided into two groups ： group 1 （ n = 137） the patients of which achieved adequate exercise end points, and group 2 （n = 90） the patients of which only reached submaximal exercise. The sensitivity of exercise MPI for detecting CAD was 86% in the group 1 and 38% in the group 2. Among the 32 patients who underwent pharmacologic stress MPI 13 had significant CAD with the sensitivity and specificity of 85% and 84% respectively. Conclusion Stress MPI is an efficient protocol for the detection of CAD in women, and pharmacologic stress MPI is more suitable for the women with decreased exercise capacity and advanced age.