^(99)Tc^m-替曲膦心肌灌注显像在冠心病诊断的应用及治疗决策的作用

^(99)Tc^m-tetrofosmin Myocardial Perfusion Imaging for Diagnosis of Coronary Heart Disease and Therapeutic Decision-making

目的评价^(99)Tc^m-替曲膦(^(99)Tc^m-Tetrofosmin)心肌灌注显像在冠心病诊断的应用及治疗决策的作用。方法 73例临床初步诊断冠心病患者行^(99)Tc^m-替曲膦心肌灌注显像,第一日行^(99)Tc^m-替曲膦静息心肌灌注显像,次日行^(99)Tc^m-替曲膦负荷(运动负荷或药物负荷)心肌灌注显像,一周内行冠状动脉造影(Coronary arteriongraphy,CAG)。对^(99)Tc^m-替曲膦心肌灌注显像阴性者36例、^(99)Tc^m-替曲膦心肌灌注显像心肌灌注显像阳性者37例与其CAG结果对比,得出^(99)Tc^m-替曲膦心肌灌注显像对胸闷、胸痛等不同症状患者心肌缺血程度的初步评测及其在治疗决策中的作用。结果^(99)Tc^m-替曲膦心肌灌注显像提示未见缺血的36例患者中,在其CAG结果中发现冠状动脉病变2支以上者3例(狭窄程度最大值不超过75%,狭窄程度均值为71.42%±3.78%),单支病变者8例(狭窄程度最大值不超过75%,狭窄程度均值为63.75%±6.94%),25例患者CAG提示冠状动脉未见狭窄,予以对症药物治疗或临床密切观察。^(99)Tc^m-替曲膦心肌灌注显像提示明显心肌缺血26例,在其CAG结果中发现冠状动脉病变2支以上者8例(狭窄程度均值为78.75%±11.34%),单支病变者14例(狭窄程度均值为78.93%±5.94%),上述22例患者均进一步行球囊扩张术和(或)支架植入术;4例患者CAG提示未见明显狭窄。^(99)Tc^m-替曲膦心肌灌注显像提示轻度心肌缺血者11例,对应其CAG结果发现冠状动脉病变2支以上者5例(狭窄程度最大值不超过80%,均值为70.91%±8.31%),单支病变者5例(狭窄程度最大值不超过80%,狭窄程度均值为68.00%±8.36%),1例患者CAG提示冠状动脉未见狭窄,均进行药物治疗。结论^(99)Tc^m-替曲膦心肌灌注显像对冠心病进行诊断、治疗方案的选择有重要的临床应用价值。

Objective To evaluate the clinical value of ^99Tc^m-tetrofosmin myocardial perfusion imaging for diagnosis of coronary heart disease and therapeutic decision-making. Methods A total of 73 patients were included in this study. All of the patients received ^99Tc^m-tetrofosmin myocardial perfusion imaging and Coronary arteriongraphy （CAG）. The rest ^99Tc^m-tetrofosmin myocardial perfusion imaging was performed on the first day, and the Stress （ exercise stress or adenosine stress） ^99Tc^m-tetrofosmin myocardial perfusion imaging was performed on the next day. CAG was performed in each patient within one week after myocardial perfusion imaging. The results were compared. The degree of myocardial ischemia in patients with different symptoms such as chest tightness, chest pain and other symptoms was evaluated based on ^99Tc^m-tetrofosmin myocardial perfusion imaging. Results ^99Tc^m-tetrofosmin myocardial perfusion imaging suggested that no ischemia in 36 cases. CAG found more than 2 blocked artery branches in 3 cases （ stenosis maximum value is less than 75%, the degree of stenosis of the mean is 71.42% ± 3.78% ） and single branch lesions in 8 cases （ stenosis maximum value is less than 75 %, the degree of stenosis of the mean is 63.75 % ± 6.94% ）. ^99Tc^m-tetrofosmin myocardial perfusion imaging suggested 26 cases as myocardial ischemia. CAG found more than 2 blocked arteries in 8 cases （ stenosis mean 78.75% ± 11.34% ）, 14 cases with singlebranch blcokage （ stenosis mean 78.93% ± 5.94% ）. These 22 patients were treated with balloon dilation and （or）percutaneous coronary intervention. ^99Tc^m-tetrofosmin myocardial perfusion imaging showed 11 cases with mild myocardial ischemia, CAG found more than 2 blocked artery branches in 5 cases （the degree of stenosis of the maximum value is less than 80%, the average is 70.91% ± 8.31% ） and 5 cases were single（ stenosis maximum value is less than 80%, the degree of stenosis of the mean is 68.00% ± 8.36% ）. Condusion ^99Tc^m-tetrofosmin myocardial perfusion imaging plays an important role in diagnosis, treatment choice and prognosis assessment in patients with coronary artery disease.