CZT SPECT心肌血流定量显像对高危冠心病患者的诊断价值

Diagnostic value of myocardial blood flow quantitative imaging with CZT SPECT in patients with high-risk coronary artery disease

目的探讨碲锌镉(CZT)SPECT心肌血流定量显像对高危冠状动脉粥样硬化性心脏病(简称冠心病;CAD)患者的诊断价值。方法回顾性分析2018年11月至2020年10月间于泰达国际心血管病医院完成CZT SPECT动态采集和常规SPECT心肌灌注显像(MPI)的148例患者[男82例、女66例,年龄(63.8±8.2)岁]。根据冠状动脉(简称冠脉)造影(CAG)结果,将患者分为高危CAD组和低中危CAD组。在患者水平,比较2组患者定量参数[负荷心肌血流量(sMBF)、静息心肌血流量(rMBF)和心肌血流储备(MFR)]、半定量参数[负荷总积分(SSS)、静息总积分(SRS)、总积分差(SDS)和一过性缺血扩张(TID)指数]及左心室功能参数,通过ROC曲线分析评价各参数诊断准确性。在血管水平,分析冠脉狭窄程度与部分参数指标的相关性。采用Mann-WhitneyU检验、logistic回归、Spearman秩相关及DeLong检验等进行统计学分析。结果基于患者水平的分析示,高危CAD组的MFR和sMBF明显低于低中危CAD组[1.36(0.87,1.64)与2.74(2.30,3.33),1.06(0.69,1.48)与2.50(1.73,2.95)ml·g-1·min-1;U值:628.00和853.50,均P<0.001]。MFR和SDS是高危CAD患者的独立预测因素[比值比(OR)=0.251(95%CI:0.136~0.464),P<0.001;OR=1.188(95%CI:1.026~1.375),P=0.021],MFR预测高危CAD的能力更强。MFR和sMBF对高危CAD的诊断准确性最高(AUC:0.885与0.844)。MFR与其他参数AUC的差异均有统计学意义(z值:1.99~6.77,均P<0.05),其最佳诊断阈值为≤1.83(灵敏度:85.90%;特异性:85.71%)。基于血管水平的分析示,MFR和sMBF与冠脉狭窄程度呈负相关(R2值:0.39与0.35,均P<0.001),SSS、SRS及SDS与冠脉狭窄程度呈正相关(R2值:0.22、0.12与0.14,均P<0.001)。结论与常规SPECT MPI相比,CZT SPECT心肌血流定量显像对高危CAD患者诊断效能更佳。

Objective To investigate the diagnostic value of myocardial blood flow quantitative imaging with cadmium zinc telluride(CZT)SPECT in patients with high-risk coronary artery disease(CAD).Methods A total of 148 patients(82 males,66 females,age:(63.8±8.2)years)who successfully completed CZT SPECT dynamic acquisition and routine SPECT myocardial perfusion imaging(MPI)in TEDA International Cardiovascular Hospital from November 2018 to October 2020 were analyzed retrospectively.According to the results of coronary angiography(CAG),patients were divided into two groups:high-risk CAD group and low-to-medium-risk CAD group.At the case level,quantitative parameters(stress myocardial blood flow(sMBF),rest myocardial blood flow(rMBF)and myocardial flow reserve(MFR)),semi-quantitative parameters(summed stress score(SSS),summed rest score(SRS),summed difference score(SDS)and transient ischemic dilation(TID))and left ventricular function parameters of two groups were compared.Diagnostic accuracy was evaluated by ROC curve analysis.At the vascular level,the correlation between the degree of coronary artery stenosis and some parameters was analyzed.Mann-Whitney U test,logistic regression,Spearman rank correlation analysis and DeLong test were used for statistical analysis.Results Case level analysis showed that MFR and sMBF in high-risk CAD group were significantly lower than those in low-to-medium-risk CAD group(1.36(0.87,1.64)vs 2.74(2.30,3.33),1.06(0.69,1.48)vs 2.50(1.73,2.95)ml·g-1·min-1;U values:628.0 and 853.5,both P<0.001).MFR and SDS were independent predictors of high-risk CAD patients(odds ratio(OR)=0.251(95%CI:0.136-0.464),P<0.001;OR=1.188(95%CI:1.026-1.375),P=0.021),and MFR was more capable of predicting high-risk CAD.MFR and sMBF had the highest accuracy in diagnosing high-risk CAD(AUCs:0.885 and 0.844).Differences of AUCs between MFR and other parameters were statistically significant(z values:1.99-6.77,all P<0.05),and the best diagnostic cut-off value was≤1.83(sensitivity:85.90%;specificity:85.71%).Vascular level analysis showed that MFR and sMBF(R2 values:0.39 and 0.35,both P<0.001)were negatively correlated with the degree of coronary stenosis,while SSS,SRS and SDS(R2 values:0.22,0.12 and 0.14,all P<0.001)were positively correlated with the degree of coronary stenosis.Conclusion Compared with conventional SPECT MPI,CZT SPECT myocardial blood flow quantitative imaging has better diagnostic efficacy and clinical value in patients with high-risk CAD.