心肌灌注断层显像与运动心电图ST段移位检测心肌缺血部位比较

Comparative study on the localization of myocardial ischemia by myocardial perfusion SPECT and exercise electrocardiography

目的 探讨运动心肌灌注断层显像与运动心电图ST段移位检测心肌缺血部位的一致性。方法 心肌灌注异常和ST段移位患者 3 0 2例 ,将ST段移位所在心肌部位与灌注异常部位进行相关性比较。结果 40例ST段抬高的患者常有心绞痛史 ,并且易为运动诱发 ,运动持续时间较短(P <0 .0 5 )。ST段压低的部位与灌注异常的部位之间存在弱一致性 (Κ =0 .3 6,P <0 .0 1) ;左前降支(LAD)支配节段的灌注异常最常伴有前壁ST段压低 (χ2 =60 6.5 ,P <0 .0 5 ) ;ST段抬高与心肌灌注异常在病变定位上完全一致 (Κ =1.0 0 ,P <0 .0 1)。结论 ST段压低与灌注异常的定位一致性差 ,而ST段抬高则与灌注异常定位显著一致。

Objective To investigate the correspondence between the myocardial perfusion SPECT and exercise electrocardiography (ECG) in localization of myocardial ischemia. Methods Three hundred and two patients with abnormal findings in the myocardial perfusion SPECT and ECG were selected and Chi-square test was performed to analyze the relationship between ECG and SPECT in determining the ischemic myocardial segment. Results Compared with patients with ST depression, most patients with ST elevation had significantly more anginal symptoms in history occurring during exercise test, and lower exercise tolerability (P<0.05). Some weak correspondence (K=0.36,P<0.01) was shown between the localization of ST depression and defect territory of myocardial perfusion, while a complete correspondence (K=1.00,P<0.01) between ST elevation and SPECT in determining the abnormal myocardial segment was observed. In patients with anterior ST depression, perfusion defects occurred more frequently in left anterior descending coronary artery (LAD) territory (66.9%) than in right coronary artery(RCA) territory (33.1%). ST segment depression related poorly with the results of myocardial perfusion in determining the defects. Conclusion The exercise-induced ST elevation is more correspondent to the defects of myocardial perfusion in the localization of myocardial ischemia compared with ST depression.