探讨门控SPECT心肌灌注显像在慢性心衰患者心脏再同步化治疗中的临床应用价值

Clinical application value of gated SPECT myocardial perfusion imaging on cardiac resynchronization therapy in patients with chronic heart failure

目的:探讨门控SPECT心肌灌注显像(GSMPI)在慢性心力衰竭(CHF)患者心脏再同步化治疗(CRT)及其预后评估中的临床应用价值。材料和方法:2012年1月—2014年6月行CRT植入且术前行GSMPI的CHF患者21例,经显像获得相位直方图带宽(PHB)、相位标准差(PSD)、左心室射血分数(LVEF)、左室舒张末容积(EDV)、静息灌注评分(SRS)及疤痕面积(SS)等功能参数。所有患者于CRT后半年复查心脏超声,以左室舒张末期内径缩小、LVEF增高(差值>5%),且半年内无再住院记录为CRT有效,将入选患者分为有效组及无效组。比较两组患者各项参数间的差异、分析其对CRT疗效的预测价值。同时记录左室内最迟激动部位。结果:CRT有效组15例(71.4%),无效组6例(28.6%),两组患者各参数之间均有统计学差异(P均<0.05),其中以PSD、PHB差异最显著(P<0.01)。左室内最迟激动部位位于心尖部、前壁、间壁者10例(47.6%),下壁者6例(28.6%),侧壁者5例(23.8%)。结论:GSMPI能够"一站式"提供多项功能参数,心脏收缩同步性定量参数及心肌梗死疤痕面积等可应用于预测术后疗效,其中PSD、PSW具有更高的预测价值;参考左室内最迟激动点及心梗疤痕部位,可应用于指导CRT电极植入。

Objective： To investigate the clinical value of gated SPECT myocardial perfusion imaging on cardiac resynchro- nization therapy（CRT） and evaluate their prognosis in patients with chronic heart failure（CHF）. Methods： Twenty one patients with CHF in 2012 January to 2014 June were assigned to CRT, and underwent gated SPECT myocardial peffusion imaging （GSMPI） before operation. Functional parameters including phase histogram bandwidth, phase standard deviation, left ventricular ejection function, end diastolic volume, summed rest scores and scar size were acquired by imaging. All patients underwent a second-time cardiac uhrasonography at the sixth month after operation. Effective therapy was considered when left ventricular end diastolic diameter decreased, LVEF increased, and no hospitalization records existed within half a year. Then, the patients were divided into effective and ineffective groups. The differences between the functional parameters of the two groups were compared, the predictive value for the efficacy of CRT was analyzed, and the latest systolic area in the left ventricule was recorded. Results： Fifteen cases （71.4%） were effective after CRT, and 6 cases （28.6%） were irresponsive. All parameters be- tween the two groups showed significant differences （P〈0.05）, and PSD and PHB were the most significant （P〈0.01）. The latest systolic area of the left ventricle was located in the apex, the anterior wall and the septal wall in 10 patients＇ （47.63%）, in the inferior wall in 6 patients （28.6%）, and in the lateral wall in 5 patients （23.8%）. Conclusion： GSMPI can provide ＂one- stop＂ multiple functional parameters, which can be used to guide CRT electrode implantation and predict curative effect. PSD and PSW might have a higher predictive value.