腺苷负荷后左室功能的变化及其与心肌缺血之间的关系

Left Ventricular Functional Changes during Adenosine Stress and Its Relationship with Myocardial Ischemia in Gated SPECT

目的研究腺苷负荷显像左室功能变化及这种变化与心肌缺血之间的关系。方法 125例疑似或确诊冠心病(CAD)患者行腺苷负荷—静息心肌灌注单光子发射断层显像(SPECT)。图像分析采用17分段及5点评分法,并计算总负荷评分(SSS)、总静息评分(SRS)及总评分差(SDS=SSS-SRS)。用左室射血分数(LVEF)、舒张末容积(EDV)及收缩末容积(ESV)表示负荷后LVEF、EDV及ESV变化。结果不可逆灌注异常组静息及腺苷负荷显像时,LVEF均显著低于灌注正常组(t=2.235,P=0.028;t=2.464,P=0.016)。腺苷负荷诱导的可逆性灌注异常组患者腺苷负荷后LVEF显著低于灌注正常组(t=3.146,P=0.002),其主要表现为腺苷负荷后ESV显著上升(t=-2.215,P=0.036)。可逆性灌注异常组的LVEF及ESV显著低于不可逆性灌注异常组(t=2.520,P=0.014;t=-2.412,P=0.019)或灌注正常组(t=3.115,P=0.002;t=-3.517,P=0.001)。结论左室功能的逐步降低是CAD患者的疾病进展的表现。心肌SPECT显像时,除了要关注腺苷负荷引起心肌心肌灌注改变之外,还应注意到左室功能的变化,协助预测预后。

Objective To investigate left ventricular functional changes during adenosine stress and its relationship with myocardial ischemia evaluated with gated single photon emission computed tomography.Methods Adenosine stress-rest protocol and gated SPECT were carried out for 125 patients suspected or known of coronary artery disease （CAD）.Perfusion analysis was performed with a 17-segment model and 5-point scale system.Summed stress score （SSS）,summed rest score （SRS）,summed difference score （SDS=SSS-SRS）,LVEF,EDV and ESV were calculated.Results Patients with irreversible ischemia had significantly lower rest and poststress LVEF compared with normal perfusion patients （t =2.235,P =0.028 ; t =2.464,P =0.016）.In patients with reversible myocardial ischemia,poststress LVEFs were significantly decreaed （t =3.146,P =0.002） which were mainly expressed as ESVs elevated （t =-2.215,P =0.036）,compared with rest.Patients with reversible ischemia showed significant changes in LVEF and ESV,compared with patients with irreversible ischemia （t =2.520,P =0.014; t =-2.412,P =0.019）,or normal perfusion （t =3.115,P =0.002 ; t =-3.517,P =0.001）.Conclusion The progressive reduction of cardiac function represents the progression of CAD.Compared with visual myocardial perfusion alone,integration of LV functional message enhanced the diagnostic ability of adenosine stress SPECT in patients with CAD.