双核素心肌显像对急性心肌梗死患者延迟经皮冠状动脉介入治疗的指导意义

Guidance of dual isotope myocardial imaging technology on delayed percutaneous coronary intervention in patients with acute myocardial infarction

目的利用18F-氟代脱氧葡萄糖(^(18)F-FDG)和^(99)Tcm-甲氧基异丁基异腈(^(99)Tcm-MIBI)双核素心肌灌注/代谢显像技术,评估急性心肌梗死(acute myocardial infarction,AMI)患者存活心肌数量对延迟经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能改善的影响。方法纳入40例AMI延迟PCI治疗的患者,术前根据^(18)F-氟代脱氧葡萄糖和^(99)Tcm-甲氧基异丁基异腈双核素心肌灌注/代谢显像结果分为心肌存活组和无心肌存活组。入院一周后行延迟PCI治疗,比较两组间PCI治疗后患者心功能改变情况。结果心肌存活组术前左心室舒张末期容量(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容量(left ventricular end-systolic volume,LVESV)为(134.5±25.3)mL及(63.7±12.2)mL,术后均显著下降,分别降至(120.6±18.7)mL及(52.3±16.4)mL,差异有统计学意义(P<0.05)。左心室射血分数(left ventricular ejection fraction,LVEF)和左心室短轴缩短率(left ventricular fractional shortening,LVFS)则由(40.6±5.4)mL和13.8%±3.0%升至(48.3±2.7)mL和22.4%±2.3%,差异有统计学意义(P<0.05)。血浆中脑钠肽浓度由(3227.8±108.2)ng/mL降至(724.7±91.3)ng/mL,差异有统计学意义(P<0.05)。无心肌存活组术前与术后比较,上述各参数均差异无统计学意义(P>0.05)。结论通过双核素心肌显像技术判断AMI患者剩余存活心肌数量,可预测AMI延迟PCI治疗后心功能改善情况,对AMI延迟PCI治疗具有指导意义。

Objectives By using the fluorine-18 fluorodeoxyglucose （^18F-FDG）/^99Tcm-sestamibi （^99Fcm-MIBI） dual isotope myocardial perfusion/metabolic imaging technology, we evaluated the improvement in cardiac function contributed by myocardial viability in acute myocardial infarction （AMI） patients treated by pereutaneous coronary intervention （PCI）. Methods Totally 40 cases of AMI patients were divided into viable and non-viable myocardium groups subjected to ^18F-FDG/^99Tcm-MIBI dual isotope myocardial perfusion/metabolic imaging. We compared the cardiac functional markers of the two groups before and one week after PCI treatment. Results Before treatment, left ventricular end-diastolic volume （LVEDV） and left ventricular end-systolic volume （LVESV） of viable myocardium group were （134.5±25.3） mL and （63.7±12.2） mL, while after treatment, they decreased to （120.6±18.7） mL and （52.3±16.4） mL, the differences were significant （P〈0.05）; left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） increased from （40.6±5.4） mL and 13.8%±3.8% to （48.3±2.7） mL and 22.4%±2.3%, the differences were significant （P〈0.05） ; plasma concentration of brain natriuretic peptide （BNP） reduced from （3227.8±108.2） ng/mL to （724.7±91.3） ng/mL, the difference was significant （P〈0.05）. However, there were no significant differences in the indexes above in non-viable myocardium group before and after surgery （P〉 0.05）. Conclusions Dual isotope myocardial imaging can effectively determine the myocardial viability in patients with being significant in guiding PCI operation in patients with AMI. intervention;markers of cardiac function