^(99)Tc^m-MIBI运动-静息心肌显像在PTCA术后的临床价值

Assessment of the value of ^(99)Tc^m-MIBI stress rest SPECT imaging for evaluation of the outcomes of percutaneous transluminal coronary angioplasty

评价99Tcm 甲氧基异丁基异腈 (MIBI)运动 静息心肌 (ST RE)SPECT显像对经皮冠状动脉腔内成形 (PTCA)术后判断疗效、预测再狭窄以及估测预后的临床价值。方法 10 0例PTCA术后患者行ST RESPECT ,30例有术前对照 ,30例复查冠状动脉造影 (CAG) ,被扩冠状动脉所支配的心肌显像如为可逆性 (RD)和 (或 )部分可逆性缺损 (PRD) ,提示心肌缺血 ,冠状动脉再狭窄可能。患者在随访期间如发生心源性死亡、急性心肌梗死、不稳定性心绞痛和行血运重建术 ,认为有心脏事件发生。结果 ① 10 0例患者中 2 8%有心肌缺血 ,心肌缺血的发生率在心肌梗死组和无心肌梗死组差异无显著性 ( 2 4 0 %和 2 4 7% ,P >0 0 5) ;② 30例患者中 ,术后心肌灌注的改善率为 76 7% ,其中 12例完全恢复正常 ;③对 30例患者共 4 5支被扩冠状动脉 ,ST RESPECT和心电图运动试验对再狭窄诊断的阳性预测值分别为 88 8%和 55 0 % ,阴性预测值分别为 85 1%和 64 0 % ,预测准确性分别为86 7%和 60 0 % ;④心脏事件发生率在缺血组和无缺血组分别为 4 6 4 % ( 13 2 8例 )和 1 4 % ( 1 72例 ) ,差异有极显著性 ( χ2 >2 4 3 ,P <0 0 0 0 1)。结论 99Tcm MIBIST RESPECT对PTCA术后疗效的判断。

Objective To assess the value of stress rest 99 Tc m MIBI (ST RE) SPECT imaging for evaluation of perfusion improvement, prediction of restenosis (RS) and cardiac event rate in patients after percutaneous transluminal coronary angioplasty (PTCA) Methods 99 Tc m MIBI ST RE SPECT imaging was performed on 100 patients [(52±9) years old] (14±15) months after PTCA On 30 of the 100 patients, ST RE SPECT imaging were also performed before PTCA, and 30 patients underwent coronary angiography (CAG) The perfusion findings of myocardial segments were qualitatively classified into four patterns: normal (N), reversible defect (RD), partial reversible defect (PRD) and fixed defect (FD) Restenosis was predicted on the basis of RD or PRD During the follow up, cardiac death, myocardial infarction (MI), unstable angina and revascularization were considered as cardiac events Results ①Among 100 patients, RD or PRD was observed in 28 patients, indicating myocardial ischemia (IS); FD was observed in 20 patients, indicating MI The rate of occurance of ischemic segments had no significant difference between patients with or without MI(P>0 05) ②Among 30 patients, perfusion imaging was improved in 23 patients, the improved rate was 76 7% The number of ischemic segments was decreased from 100 (37%) before PTCA to 10 (3 7%) after PTCA (P<0 000 1) ③RS was detected in 12 of 30 patients or in 20 of 45 vessels Sensitivity, specificity, positive predictive value and negative predictive value and accuracy of ST RE SPECT for predicting RS were 83 3%, 92 0%, 88 8%, 85 1% and 86 7%, respectively ④During follow up, rate of cardiac event was 46 4% (13/28) in ischemic group and that was significantly higher than that in non ischemic group (1 4%, 1/72, P<0 000 1) Conclusions ST RE 99 Tc m MIBI SPECT is a useful noninvasive method for evaluating the effect of PTCA and for predicting RS, and it is of high value for predicting cardiac events