小剂量腺苷负荷超声心动图试验与双核素心肌显像检测急性心肌梗死后患者存活心肌比较

Comparision of low-dose adenosine echocardiography and dual-isotope emission simultaneous acquisition for assessment of myocardial viability in early acute myocardial infarction

目的:比较小剂量腺苷负荷超声心动图试验(LDASE)与99mTc-甲氧基异丁腈(MIBI)/18F-脱氧葡萄糖(FDG)双核素同时采集法(DISA)单光子发射断层显像(SPECT)对急性心肌梗死(AMI)患者早期存活心肌检出的准确性。方法:对36例AMI患者于发病后3～10d内行LDASE与DISA-SPECT。所有患者在LDASE前后接受经皮冠状动脉介入治疗术。AMI后3个月随访二维超声心动图,以局部室壁运动改善作为心肌存活的金标准,比较2种方法检测存活心肌的敏感性和特异性。结果:LDASE检出存活心肌敏感性为90.3%,特异性为80.8%,阳性预测值与阴性预测值分别为84.8%和87.5%,准确性为86.0%;DISA-SPECT检出存活心肌敏感性81.2%,特异性78.3%,阳性预测值81.1%,阴性预测值83.1%,准确性80.2%。2种方法对运动异常节段存活心肌检出一致性为72.6%,差异无统计学意义。结论:对AMI后患者,LDASE与DISA-SPECT均为检出存活心肌较敏感和特异的技术。

Objective： To compare low-dose adenosine echocardiography（LDASE） and dual-isotope emission simultaneous acquisition （ technetium-99-m-tetrofosmin/fluorine 18 fluorodeoxy-glueose） single-photon emission computed tomography（DlSA-SPECT） for assessment of viable myocardium in patients with acute myocardial in farction（AMI）. Method： Thirty-six patients with a first AMI underwent LDASE within 3-10 days after onset of AMI. Percutaneous coronary intervension was made before or after LDASE. A 17-segment semi-quantitative scoring model was adopted. Wall motion improvement derived from two dimensional images at follow-up （3 months after AMI ） compared with baseline before adenosine infusion was used as gold criteria for myocardial viability. Result：The sensitivity, specificity, diagnostic accuracy, positive and negative predictive value for identification of viable myocardium were 90.3%, 80.8%, 86.0%, 84.8% and 87.5%, respectively by LDASE and 81.2%, 78.3%, 80.2%, 81. 1% and 83.1%, respectively by DISA-SPECT. Overall agreement between two techniques to detect viable myocardium was 72.6 %. Conclusion：Sensitivity and specificity were both high by LDASE and DISA for detecting viable myocardium in AMI patients.