腺苷负荷心肌灌注显像评估川崎病心肌缺血的价值

Adenosine Stress Myocardial Perfusion Imaging in Evaluating Myocardial Ischemia in Kawasaki Disease

目的 探讨腺苷负荷心肌灌注显像(MPI)评估儿童川崎病心肌缺血的安全性及临床价值。资料与方法 前瞻性收集2019年8月—2021年2月复旦大学附属儿科医院有川崎病病史且经超声心动图和冠状动脉造影明确有冠状动脉瘤者78例,行腺苷负荷MPI,分析腺苷负荷试验的安全性,并检测冠状动脉明显狭窄(≥75%)的敏感度和特异度,比较不同冠状动脉狭窄程度组腺苷负荷MPI阳性率的差异。结果 78例患儿均完成腺苷负荷试验,无严重副作用发生。其中44例负荷试验阴性者未行静息显像,减少了56.4%(44/78)的辐射暴露。腺苷负荷MPI检测冠状动脉明显狭窄的敏感度为66.7%,特异度为60.6%(40/66)。冠状动脉无狭窄组40.3%(21/52)、轻中度狭窄组35.7%、明显狭窄组66.7%的患儿负荷试验阳性,阳性率差异无统计学意义(χ^(2)=3.169,P=0.205)。结论 腺苷负荷试验在儿童中安全可行,负荷优先成像策略可减少辐射暴露,腺苷负荷MPI对评估、监测川崎病患儿心肌缺血具有重要价值。

Purpose To study the safety and clinical value of adenosine stress myocardial perfusion imaging(MPI)in evaluating myocardial ischemia in children with Kawasaki disease.Materials and Methods A total of 78 children with a history of Kawasaki disease and coronary artery aneurysm confirmed by echocardiography and coronary angiography were prospectively studied in Children's Hospital of Fudan University from August 2019 to February 2021.Adenosine stress MPIs were performed to analyze the safety of adenosine stress test and its sensitivity and specificity in detecting significant coronary artery stenosis(≥75%),and the positive rate of adenosine stress MPIs in different groups of coronary artery stenosis were further compared.Results All 78 children completed adenosine stress test without serious side effects.Among 78 children with adenosine stress imaging,44 patients with negative adenosine stress imaging did not undergo rest imaging,which reduced radiation exposure by 56.4%(44/78).The sensitivity and specificity of adenosine stress MPIs in detecting significant coronary artery stenosis were 66.7%and 60.6%(40/66),respectively.Adenosine stress MPIs were positive in 21 cases(21/52,40.3%)in non-stenosis group,5 cases(35.7%)in mild to moderate stenosis group,and 8 cases(66.7%)in significant stenosis group.There was no significant difference in the positive rate among the three groups(χ^(2)=3.169,P=0.205).Conclusion Adenosine stress test is safe and feasible in children.The stress-first imaging strategy can reduce radiation exposure.Adenosine stress MPI has important clinical value in evaluating and monitoring myocardial ischemia in children with Kawasaki disease complicated with coronary aneurysm.