负荷及静息门控心肌SPECT显像左室功能的差异及与心肌缺血间的关系

Adenosine-induced Left Ventricular Functional Changes and Its Relationship With Myocardial Ischemia Evaluated With Gated SPECT

选取104例疑似或确诊的冠心病患者行腺苷负荷-静息门控心肌灌注断层显像,研究了一日法负荷-静息显像判断静息与负荷状态左室功能的差异及与心肌缺血之间的关系。将左室分为17节段,采用5点评分法对心肌缺血进行评分,并计算出总负荷评分(SSS)、总静息评分(SRS)及评分差(SDS=SSS-SRS)。将SSS≥4作为存在缺血指标,SDS≥3为可逆性灌注异常指标。结果显示,负荷与静息显像左心室射血分数LVEF有很好的相关性。以所有患者为整体来观察,静息显像与负荷显像间无显著性差异(t=-0.655,P>0.05)。将所有患者分为可逆心肌缺血组及非可逆心肌缺血组,非可逆心肌缺血患者组静息及负荷后LVEF、EDV(舒张末容积)、ESV(收缩末容积)之间均无显著差异;而可逆心肌缺血组负荷显像LVEF、EDV、ESV均显著低于静息显像。以上结果提示,腺苷诱导可逆性缺血患者负荷显像LVEF明显低于静息显像;负荷显像LVEF有所降低,也预示其心肌缺血的可能性明显增加。

To investigate the relationship between myocardial ischemia during adenosine stress testing and the changes in left ventricular ejection fraction（LVEF） measurements after stress and rest geted myocardial perfusion imaging.104 patients suspecting myocardial ischemia underwent adenosine stress-rest protocol and gated single photon emission computed tomography（SPECT）.Perfusion analysis was performed with a 17-segment model.Myocardial ischemia were assessed with 5-point scale.Summed stress score（SSS）,summed rest score（SRS） and summed difference score（SDS=SSS-SRS） were calcurated.An SSS score exceeding 3 points was considered positive for coronary artery disease,and SDS greater than 2 indicated resersiable ischemia.Resting and poststress LVEFs correlated significantly,and there was no significant difference between stress and rest（t=-0.655,P0.05）.However,patients with reversible ischemia had significant differences in poststress versus resting LVEF,EDV and ESV.In patients with stress-induced perfusion ischemia,the LVEF after stress was significantly lower than the rest.LVEF descending in adenosine imaging indicated myocardial ischemia.