心肌SPECT显像观察卡托普利对犬心肌梗死后左心室重构的作用

The Effect of Captopril on Early Left Ventricular Remodeling Assessed by ^(99)Tc^m-MIBI Myocardial Imaging in Acute Experimental Myocardial Infarction

目的应用心肌SPECT显像观察卡托普利对实验犬急性心肌梗死后早期左心室重构的预防作用。材料与方法 34只杂种犬采用完全随机分组方法分为对照组(n=23)和治疗组(n=11)。开胸结扎所有犬的左前降支制作心肌梗死模型。治疗组术前3d口服卡托普利20mg,每天2次。术后6h行SPECT心肌显像,观察两组术前与术后左心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)的变化。结果①对照组与治疗组分别有16只犬和6只犬成功建立模型并纳入实验。②对照组术前左心室EDV、ESV与术后比较,差异有统计学意义(t=2.81、2.83,P<0.05);术前EF与术后比较,差异无统计学意义(t=0.06,P>0.05)。治疗组术前EDV、ESV、EF与术后比较,差异均无统计学意义(t=0.76、0.56、1.20,P<0.05);两组术前EDV、ESV差异无统计学意义(t=0.08、0.94,P>0.05),术后EDV﹑ESV差异有统计学意义(t=6.12、9.91,P<0.05),EF差异无统计学意义(t=0.79,P>0.05)。结论急性心肌梗死前预防性使用卡托普利可阻止早期左心室重构;心肌SPECT显像对评价预防性使用卡托普利控制急性心肌梗死后早期左心室重构有重要价值。

Purpose To investigate if captopril administrated before acute myocardial infarction can prevent early remodeling of the left ventricle. Materials and Methods The left anterior descending coronary artery was ligated between the first and second diagonal branches for 34 healthy mongrel dogs. Then the 34 dogs were randomized into the control group （n=23, no treatment ） and the captopril group （n=11, administed catopril 20mg bid 3 days before ligation of coronary artery）. Each dog underwent 99Tcm-MIBI SPECT myocardial imaging 48-72 hours before operation and 6 hours after myocardial infarction. Results The effective sample size was 22 with 16 dogs in control group and 6 dogs in captopril group. In control group, post-operation EDV and ESV significantly increased （t = 2.81, 2.83, P 0.05）. Post-operation EF showed no significant statistical difference （t =0.06, 2.83, P 0.05）. In captopril group, post-operation EDV, ESV and EF had no significant statistical difference （t=0.76, 0.56, 1.20, P 0.05）. At 6 hours, EDV and ESV were reduced in the captopril group （t=6.12, 9.91, P 0.05） while EF improved only slightly with no statistical significance （t = 0.79, P 0.05）. Conclusion Compared with control group without treatment, captopril limits myocardial remodeling by preventing the increase in ventricular volume. 99Tcm-MIBI SPECT myocardial imaging is a useful and noninvasive technique for evaluating left ventricular remodeling following acute myocardial infarction.