CAJ | 학술논문

目的采用99Tcm-MIBI加18F-FDG双核素心肌灌注-代谢显像(DISA)评价冠心病心肌梗死患者有无存活心肌,以判断择期血运重建后存活心肌对左心功能的影响.方法选择确诊心肌梗死患者91例,行DISA.根据超声心动图(UCG)结果将患者分为心功能不全(A组)和心功能正常(B组)2组,在行PCI术后1,3和6个月观察UCG结果.采用SPSS 13.0软件进行统计学处理,2组间均值比较采用t检验,率的比较采用χ2检验.结果 A组灌注平均缺损(9.8±3.5)个节段,B组灌注平均缺损(5.4±2.6)个节段;2组相比,t=6.87,P<0.01.A组代谢平均缺损(7.5±3.4)个节段,B组代谢平均缺损(4.6±2.8)个节段,2组相比,t=4.46,P<0.01.A组检出存活心肌173个节段,占37.8%(173/458),B组检出188个节段,占61.2%(188/307),2组相比,χ2=40.61,P<0.001.A组灌注显像总评分(SPS)为(28.43±11.86)分,代谢显像总评分(SMS)为(20.17±8.52)分,(代谢-灌注)总评分之差(SDS)为(0.39±3.17)分;B组SPS为(21.36±9.54)分,SMS为(15.19±5.74)分,SDS为(-12.72±4.55)分,2组相比,t=3.15,3.32和15.59,P均<0.01.A组存活心肌≥4个节段的LVEF升高差值(ΔLVEF)为(12.81±2.62)%,明显高于B组的(5.90±1.91)%,t=16.33,P<0.001;左心室舒张末期内径回缩差值(ΔLVEDd)为(-13.13±4.20) mm,也明显高于B组(-7.75±2.31) mm,t=6.86,P<0.001;A组存活心肌<4个节段的ΔLVEF和ΔLVEDd则明显低于B组,t=3.25和4.92,P均<0.01.结论心肌梗死区是否有存活心肌及存活心肌节段数可能是择期血运重建后左心功能改善程度的重要影响因素.
목적 채용99Tcm-MIBI가18F-FDG쌍핵소심기관주-대사현상(DISA)평개관심병심기경사환자유무존활심기,이판단택기혈운중건후존활심기대좌심공능적영향.방법 선택학진심기경사환자91례,행DISA.근거초성심동도(UCG)결과장환자분위심공능불전(A조)화심공능정상(B조)2조,재행PCI술후1,3화6개월관찰UCG결과.채용SPSS 13.0연건진행통계학처리,2조간균치비교채용t검험,솔적비교채용χ2검험.결과 A조관주평균결손(9.8±3.5)개절단,B조관주평균결손(5.4±2.6)개절단;2조상비,t=6.87,P<0.01.A조대사평균결손(7.5±3.4)개절단,B조대사평균결손(4.6±2.8)개절단,2조상비,t=4.46,P<0.01.A조검출존활심기173개절단,점37.8%(173/458),B조검출188개절단,점61.2%(188/307),2조상비,χ2=40.61,P<0.001.A조관주현상총평분(SPS)위(28.43±11.86)분,대사현상총평분(SMS)위(20.17±8.52)분,(대사-관주)총평분지차(SDS)위(0.39±3.17)분;B조SPS위(21.36±9.54)분,SMS위(15.19±5.74)분,SDS위(-12.72±4.55)분,2조상비,t=3.15,3.32화15.59,P균<0.01.A조존활심기≥4개절단적LVEF승고차치(ΔLVEF)위(12.81±2.62)%,명현고우B조적(5.90±1.91)%,t=16.33,P<0.001;좌심실서장말기내경회축차치(ΔLVEDd)위(-13.13±4.20) mm,야명현고우B조(-7.75±2.31) mm,t=6.86,P<0.001;A조존활심기<4개절단적ΔLVEF화ΔLVEDd칙명현저우B조,t=3.25화4.92,P균<0.01.결론 심기경사구시부유존활심기급존활심기절단수가능시택기혈운중건후좌심공능개선정도적중요영향인소.
Objective To evaluate the effect of myocardial viability on left ventricular function after elective revascularization in patients with myocardial infarction by 99Tcm-MIBI and 18F-FDG dual-isotope simultaneous acquisition (DISA) myocardial perfusion-metabolic imaging. Methods Ninety-one patients clinically confirmed of myocardial infarction underwent DISA imaging. Based on the results of echocardiography, the patients were divided into heart failure group (group A) and normal cardiac function group (group B). After PCI, left ventricular function was measured by echocardiography in 1, 3 and 6 months. The t-test and χ2-test were used to compare the difference between the two groups using SPSS 13.0. Results The average number of diseased segments by myocardial perfusion imaging was 9.8±3.5 and 5.4±2.6 in groups A and B, respectively (t=6.87, P<0.01). The average number of diseased segments by myocardial metabolic imaging was 7.5±3.4 and 4.6±2.8 in groups A and B, respectively (t=4.46, P<0.01). There were 173 segments with viable myocardium (173/458: 37.8%) in group A and 188 segments with viable myocardium (188/307: 61.2%) in group B (χ2=40.61, P<0.001). The summed perfusion score (SPS), summed metabolism score (SMS) and summed difference score (SDS=SMS-SPS) were 28.43±11.86 vs 21.36±9.54, 20.17±8.52 vs 15.19±5.74 and 0.39±3.17 vs -12.72±4.55, respectively in groups A and B (t=3.15, P<0.01; t=3.32, P<0.01; t=15.59, P<0.01). The mean change of LVEF (ΔLVEF) and the mean change of left ventricular end-diastole dimension (ΔLVEDd) of the patients with more than 4 viable myocardial segments in group A were significantly more than those in group B( (12.81±2.62)% vs (5.90±1.91)%, t=16.33, P<0.001; (-13.13±4.20) mm vs (-7.75±2.31) mm, t=6.86, P<0.001). However, the ΔLVEF and ΔLVEDd of the patients with less than 4 viable myocardial segments in group A were significantly less than those in group B (t=3.25, P<0.01; t=4.92, P<0.001). Conclusion The amount of viable myocardium in infarct myocardium is an important factor for left ventricular function recovery after elective revascularization.