左前降支狭窄患者心肌灌注显像的应用研究

Myocardial perfusion imaging in patients with simple anterior descending branch stenosis

目的:探讨心肌灌注显像在单纯左前降支狭窄患者,尤其是青年冠心病的影像学特点。方法:回顾性分析33例经冠状动脉造影明确单纯前降支狭窄的患者资料,分析心肌灌注显像结果,并与冠脉造影结果比较。根据年龄将33例患者进一步分为A组(≤45岁)、B组(>45岁),比较分析青年冠心病患者心肌灌注显像特点。结果:(1)28例前降支狭窄≥50%患者中,20例心肌灌注减低,灵敏度为71.4%,随着前降支狭窄程度加重,灵敏度进一步增高;20例心肌灌注减低患者心肌缺血部位主要位于心尖部、前壁、前间隔、前侧壁,与前降支供血区域符合程度较高;心肌灌注总积分与冠状动脉SYNTAX积分呈正相关(r=0.408,P<0.05);(2)A组(≤45岁)患者心肌灌注显像所显示心肌缺血部位主要位于前壁、心尖部,心肌缺血程度显著小于B组(>45岁)患者(1.6±1.7对5.1±6.6,P<0.05),两组患者前降支狭窄程度、SYNTAX积分无显著差异(68.0±20.5对63.8±20.2;10.8±5.2对9.8±6.3,P>0.05)。结论:心肌灌注显像能有效评价单纯左前降支狭窄患者,包括青年冠心病患者的心肌缺血部位、程度及范围,是一项重要的无创影像检查方法,与冠脉CT等检查相比,有其不可替代的优势。

Objectives To explore the imaging features of myocardial perfusion imaging in patients with simple anterior descending branch stenosis,especially in young patients.Methods 33 patients with anterior descending branch stenosis,were analyzed retrospectively.99 mTc-methoxyisobutylisonitrile(MIBI)myocardial perfusion images were performed in all.Imaging results were compared with the results of coronary arteriography.33 patients were divided into two groups according to the age.There were 5 cases in group A(≤45 years old)and 28 cases in group B(>45 years old).The results of myocardial perfusion imaging and coronary angiography of the two groups were compared and analyzed.Results(1)Among the 28 patients with anterior descending branch stenosis greater than or equal to 50%,20 patients had decreased myocardial perfusion with a sensitivity of 71.4%.The sites of myocardial ischemic were mainly located at the apex of the heart,the anterior wall,the anterior septum,and the anterior lateral wall.The summed score of Myocardial perfusion Imaging was positively correlated with SYNTAX score(r=0.408,P<0.05);(2)In the myocardial perfusion images,we found that the sites of myocardial ischemic of group A(≤45 years old)were mainly located at the apex of the heart,the anterior wall,and the degree of myocardial ischemia was significantly lower than that of group B(>45 years old)(1.6±1.7 vs 5.1±6.6,P<0.05).The degree of anterior descending branch stenosis and SYNTAX score of group A(≤45 years old)had no difference compared with group B(>45 years old)(68.0±20.5 vs 63.8±20.2;10.8±5.2 vs 9.8±6.3,P>0.05).Conclusions Myocardial perfusion imaging can effectively evaluate the location,degree and size of myocardial ischemia of the patients with simple left anterior descending artery stenosis,including young patients.It is an important non-invasive examination method.