扩张型心肌病患者99 Tcm-MIBI心肌摄取与左室同步性的关系

Relationship between the myocardial 99 Tcm-MIBI uptake and the left ventricular synchronization in patients with dilated cardiomyopathy

目的分析扩张型心肌病（DCM）患者左室各壁心肌99Tcm-MIBI摄取情况，探讨其与左室同步性的关系。方法选取43例初次确诊为DCM的患者[男30例，女13例，年龄（50．58±13．29）岁]，以QRS波时限作为左室收缩同步性分组标准对患者进行分组：QRS正常（QRS波时限〈120ms）的24例作为同步组，QRS增宽（QRS波时限≥120ms）的19例作为不同步组。分析患者99Tcm-MIBI静息门控MPI结果，应用定量门控心肌灌注显像（QPS）软件计算得到2组LVEF、PFR、ESV、EDV等心功能参数，并计算受检者左室心尖、前壁、侧壁、下壁及间隔的99Tcm-MIBI摄取百分数、摄取减低程度及范围。应用IBMSPSS21．0软件进行独立样本t检验和Mann-Whitney u检验。结果同步组和不同步组LVEF分别为（26．44±5．59）％和（23．70±5．27）％（t=1．240，P〉0．05），其余3个心功能参数在2组间的差异也均无统计学意义（t=0．195、0．113、0．291，均P〉0．05）。2组5个节段的99Tcm-MIBI摄取百分数差异均无统计学意义（t=-0．712～1．059，均P〉0．05）。不同步组下壁摄取减低程度（0．6～3．3s）、范围（0。65％）均较同步组相应值（0．1—2．5s，0—36％）明显增高（z：-2．266、-2．391，均P〈0．05）。结论99Tcm-MIBI心肌摄取分析可以显示DCM患者心肌受损部位、程度及范围；左室下壁99Tcm-MIBI摄取减低程度及范围对DCM患者左室同步性存在显著影响。

Objective To analyze the relationship between left ventricular myocardial 99 Tcm-MIBI uptake and the left ventricular synchronization in patients with dilated cardiomyopathy （ DCM） . Methods Forty-three cases （30 males and 13 females, age （50.58±13.29） years） with DCM who underwent 12-lead electrocardiogram and rest gated MPI were included. Among them, 24 cases with QRS duration 〈120 ms was regarded as synchronous group, and 19 cases with QRS duration≥120 ms was regarded as dyssynchro-nous group. LVEF, PFR, ESV, EDV were recorded, and myocardial uptake of 99 Tcm-MIBI, severity and extent in area of apex, anterior, lateral, inferior and septum wall of left ventricle were calculated respective-ly by quantitative perfusion SPECT （ QPS） software. Independent sample t test and Mann-Whitney u test were used for data analysis with IBM SPSS 21.0. Results The values of LVEF were （26.44±5.59）% and （23.70±5.27）% in synchronous group and dyssynchronous group respectively （t=1.240, P〉0.05）. The other three cardiac function parameters had no significant differences between the two groups （ t： 0. 195, 0.113, 0.291, all P〉0.05） . There were no significant differences of myocardial 99 Tcm-MIBI uptake between two groups in all segments of apex, anterior, lateral, inferior and septum wall （ t： -0.712-1.059, all P〉0.05）. Deeper severities （0.6-3.3 s） and wider abnormal extents （0.65%） of myocardial 99Tcm-MIBI up-take were found only in the area of inferior wall in synchronous group, compared to those in dyssynchronous＆amp;nbsp;group （0.1-2.5 s, 0-36%; z=-2.266, -2.391, both P〈0.05）. Conclusions Myocardial injury （loca-tion, severity and extent）in patients with DCM could be detected by myocardial 99Tcm-MIBI imaging. The se-verity and extent of myocardial injury may have a significant impact on the left ventricular synchronization.