SPECT在冠心病危险度分层方面的应用

Risk stratification assessed by single photon emission computed tomography in coronary artery disease

应用门控心肌灌注SPECT测得的心肌灌注缺损和负荷后左室射血分数(leftventricu鄄larejectionfraction,LVEF)相结合进行危险度分层,对非致死性心肌梗死和心脏性死亡的风险进行评估以指导临床选择最佳治疗方案。对于射血分数(ejectionfraction,EF)≥30%,总差值分(即总负荷评分与总静息评分的差值,summeddifferencescore,SDS)>7的中高危患者,宜进行血流重建术(revascularization);SDS为2～7的患者,若EF>50%则为低危,可给予药物治疗,而EF为30%～50%者则予药物治疗及血流重建术;若为未见心肌缺血的极低危患者,则宜药物治疗。

Using the combination of the myocardial perfusion and poststress ejection fraction(EF) by the gated myocardial SPECT in the risk stratification for the patients who had coronary artery diseases to assess the risk of nonfatal myocardial infarction versus cardiac death can assist in determining the appropri-ate treatment strategy for the individual patient. With EF≥30% and SDS(summed difference score)>7,the patients who are at intermediate or higher risk of cardiac death might benefit more from revasculariza-tion; patients with SDS 2~7 and EF>50% are at low risk and aggressive medical therapy might be pre-ferred; while those with EF 30%~50% are at intermediate risk and might benefit more from early invasive strategy in conjunction with medical therapy; and the patients with no evidence of ischemia on perfusion imaging, who have very low risk of cardiac death and therefore, might benefit more from initial medical therapy.