腺苷负荷心肌灌注显像正常女性中心电图呈缺血改变35例分析

The analysis in 35 female patients of ischemia change in electrocardialgram with normal myocardial perfusion imaging in adenosine stress test

目的:探讨腺苷负荷心电图(ECG)呈缺血性改变而核素心肌灌注显像(MPI)正常的女性患者,MPI和冠状动脉CT(CTCA)结果对冠心病(CAD)诊断的临床价值。方法:回顾性分析2008年5月至2011年11月疑诊冠心病行腺苷负荷/静息MPI的4 142例女性患者资料,将其中35例〔年龄39～76岁,平均年龄(55.74±9.43)岁〕腺苷负荷ECG呈缺血改变,但MPI正常者作为研究对象,35例患者均利用SPECT/CT行MPI和同机CTCA检查,其中1例患者在1个月内行冠状动脉造影(CAG)检查。结果:35例患者静息状态ECG均正常,腺苷负荷ECG则出现ST段水平或下斜型下移≥0.1 mV,停止负荷1 min后ECG恢复正常,提示心肌缺血改变,随后的负荷/静息MPI均未见心肌缺血改变。同机CTCA结果示:27例冠状动脉正常(27/35,77.1%),7例冠状动脉粥样硬化性改变(7/35,20.0%),1例(2.9%)为3支冠状动脉狭窄性病变,程度均≥50%,其CAG显示:LAD近段狭窄75%,LCX中段狭窄90%,RCA近中段狭窄95%。结果提示:此组患者中97.1%的冠状动脉是正常或仅呈硬化性改变,而无心肌缺血存在。结论:女性患者易出现负荷ECG"假阳性";负荷MPI是评价此类患者有无冠心病的重要手段;同机CTCA则是避免冠状动脉3支病变而MPI"假阴性"的弥补手段,因此,利用SPECT/CT施行同机MPI/CTCA是对此类患者进行冠心病筛查的准确性较高的无创性评价手段。

Objective： Investigating the clinical value with myocardial perfusion imaging （MPI） and computed tomography coronary artery （CTCA） in diagnosing coronary artery disease （CAD） of female patients with normal MPI but ischemia change in electrocardiogram （ECG） during adenosine stress test. Methods：Ana- lyzing 4 142 female patients data retrospectively with adenosine stress/rest MPI imaging from May. 2008 to No- vember. 2011 because of suspecting CAD including 35 female patients age from 39 to 76, mean age 55.74±9.43 with ischemia change in ECG during adenosine stress test but normal in MPI. 35 female patients underwent MPI/CTCA by single photon emission computed tomography/integrated computer tomography including 1 pe- tients underwent coronary artery angiography （CAG）in one month. Results：The ECG with 35 female patients were normal at rest while the ST segment horizontally or inclined moved down ≥0. 1 mV at adenosine stress test which was showing myocardial ischemia change,and recovering to narmal in ECG after 1 min and the subsequent MPI were nannal. The integrated CTCA showed：among 35 petients, normal coronary arteries in 27 patients（27/ 35,77. 1% ） ,sclerosing change in 7 ones（7/35,20. 0% ） ,1 patient （2. 9% ） was three-vessel disease with all the vessel stenosis^50% ,with CAG showing：proximal LAD stenosis 75% ,middle LCX 90% and proximal and mid-die RCA 95%. The result indicated that 97. 1% of the coronary arteries were normal or sclerosing with no ische- mia in MIP in this group patients. Conclusion：Female paients are easier to get false positive results in diagnosing CAD in stress ECG,and MPI is a significant method to evaluate these patients whether they have CAD. Integrated CTCA is an important method to avoid false negative due to three-vessel coronary disease in MPI. So it is accurate and noninvasive evaluation method to screen CAD with MPI combined with integrated CTCA for these patients.