闭塞冠状动脉供血区域心肌存活性的评价

Evaluation of myocardial viability in regions subtended by occluded coronary arteries

目的：探讨慢性闭塞冠状动脉供血区域心肌的存活性。方法：对冠状动脉造影证实的冠状动脉慢性闭塞患者４６ 例，分别行低剂量多巴酚丁胺（ＤＯＢ）加硝酸甘油（ＮＴＧ）负荷二维超声心动图（２－ＤＥ）试验及运动加ＮＴＧ介入９９ｍ Ｔｃ－ＭＩＢＩ心肌单光子发射计算机体层摄影术（ＳＰＥＣＴ）显像。结果：４６ 例患者造影发现慢性闭塞冠状动脉５０ 支，根据是否有心肌梗死病史分为无梗死组１６例，梗死组３０ 例，负荷２－ＤＥ法判断无梗死组闭塞冠状动脉供血区均有存活性，心肌显像判断上述部位存在明显缺血，但仍具有存活性，两种方法结果一致。负荷２－ＤＥ法判断梗死组４０％ 患者（１２／３０）梗死区域有存活性，心肌显像判断梗死组２６．７％ 患者（８／３０）梗死区有存活性，两种检测方法的结果相符。结论：无心肌梗死病史患者闭塞冠状动脉供血区域有明显缺血，但均具有存活性，部分陈旧性心肌梗死患者相关动脉虽慢性闭塞，但梗死区仍具有存活性。

Objective:The aim of this study was to identify the myocardium viability in the regions supplied by completely occluded coronary artery.Method:46 patients,angiography demonstrated all of them had completely occluded coronary artery,were underwent overload test with exercise and nitroglycerin administration SPECT and low dose dobutamine+nitroglycerin stress 2 DE.Result:The region subtended by occluded coronary arteries was viable but the myocardium was ischemic in patients without previous MI,the result of 2 DE was similar to SPECT.In patients with previous MI, viability of myocardium infarction zone was detected in 12 of 30 patients(40%) by 2 DE and 8 of 30 patients( 26.7 %) by SPECT,respectively. The results of 2 DE and SPECT were comparative (P> 0.05 ).Conclusion:The myocardium subtended by occluded coronary arteries was viable but ischemic in patients without previous MI. The myocardium of infarction zone was viable in part patients with previous MI, although infarction culprit vessels were occlusive.