CAJ | 학술논문

目的分析冠状动脉慢性闭塞病变(CTO)患者SPECT G-MPI相位图,探讨其在CTO患者中的应用价值.方法回顾性分析2012年中国CTO俱乐部的21例CTO患者[均为男性,年龄37～ 77(平均56.6)岁].患者术前完成99Tcm-MIBI G-MPI和18F-FDG心肌代谢显像.应用G-MPI所测LVEF评价左心室功能,并将患者分为2组:正常组(11例,LVEF＞60％)和非正常组(10例,LVEF≤60％).采用两样本t检验或Wilcoxon秩和检验比较2组患者的LVEF、灌注/代谢缺损、左心室收缩同步性参数,分析CTO患者中同步性参数[峰相位,相位标准差(SD),相位图带宽、偏斜及陡度]与LVEF的线性相关性.结果 21例CTO患者闭塞时间为3～ 60个月,相位SD和相位图带宽均高于健康参考值,分别为(30.8±28.3)°与(14.2±5.1)°,t=3.09; (58.1±39.4)°与(38.7±11.8)°,t=2.61,均P＜0.05.这2个参数与LVEF均呈负相关(r=-0.785、-0.883,均P＜0.01),而相位图偏斜和陡度与LVEF均呈正相关(r=0.755、0.666,均P＜0.01).正常组患者LVEF高于非正常组患者:(69.3±4.7)％与(44.7±13.0)％,t=-5.65,P＜0.01;灌注缺损比例低于非正常组:4.0％与16.0％;Z=-2.23,P＜0.05;代谢缺损比例差异无统计学意义(Z=-1.82,P＞0.05).正常组相位SD及相位图带宽显著低于非正常组,分别为(18.7± 19.0)°与(44.2±31.6)°,t=2.21;(36.4± 12.7)°与(82.1±45.4)°,t=3.08,均P＜0.05.相位图偏斜、陡度正常组高于非正常组:5.11±0.75与3.55±1.05,t=-3.89; 30.77± 10.49与15.66±10.12,t =-3.35,均P＜0.01.结论 CTO患者左心室收缩同步性较健康人差,核素显像相位图同步性参数可有效预测左心室泵功能.
목적 분석관상동맥만성폐새병변(CTO)환자SPECT G-MPI상위도,탐토기재CTO환자중적응용개치.방법 회고성분석2012년중국CTO구악부적21례CTO환자[균위남성,년령37～ 77(평균56.6)세].환자술전완성99Tcm-MIBI G-MPI화18F-FDG심기대사현상.응용G-MPI소측LVEF평개좌심실공능,병장환자분위2조:정상조(11례,LVEF＞60％)화비정상조(10례,LVEF≤60％).채용량양본t검험혹Wilcoxon질화검험비교2조환자적LVEF、관주/대사결손、좌심실수축동보성삼수,분석CTO환자중동보성삼수[봉상위,상위표준차(SD),상위도대관、편사급두도]여LVEF적선성상관성.결과 21례CTO환자폐새시간위3～ 60개월,상위SD화상위도대관균고우건강삼고치,분별위(30.8±28.3)°여(14.2±5.1)°,t=3.09; (58.1±39.4)°여(38.7±11.8)°,t=2.61,균P＜0.05.저2개삼수여LVEF균정부상관(r=-0.785、-0.883,균P＜0.01),이상위도편사화두도여LVEF균정정상관(r=0.755、0.666,균P＜0.01).정상조환자LVEF고우비정상조환자:(69.3±4.7)％여(44.7±13.0)％,t=-5.65,P＜0.01;관주결손비례저우비정상조:4.0％여16.0％;Z=-2.23,P＜0.05;대사결손비례차이무통계학의의(Z=-1.82,P＞0.05).정상조상위SD급상위도대관현저저우비정상조,분별위(18.7± 19.0)°여(44.2±31.6)°,t=2.21;(36.4± 12.7)°여(82.1±45.4)°,t=3.08,균P＜0.05.상위도편사、두도정상조고우비정상조:5.11±0.75여3.55±1.05,t=-3.89; 30.77± 10.49여15.66±10.12,t =-3.35,균P＜0.01.결론 CTO환자좌심실수축동보성교건강인차,핵소현상상위도동보성삼수가유효예측좌심실빙공능.
Objective To evaluate the clinical value of phase diagrams in G-MPI for patients with chronic total occlusive coronary artery disease (CTO).Methods Twenty-one CTO patients (all males,average age:56.6 years,age range:37-77 years) from CTO Club of China in 2012 were retrospectively analyzed.99Tcm-MIBI myocardial perfusion and 18F-FDG myocardial metabolic imaging were performed.Patients were divided into normal group with LVEF＞60％ (n=11) and abnormal group with LVEF≤60％ (n=10).Differences of LVEF,perfusion/metabolic deficit and synchrony were compared by two-sample t test or Wilcoxon rank sum test.Correlations between LVEF and synchrony were analyzed by linear correlation analysis in all CTO patients.The synchrony parameters included peak phase,phase standard deviation (SD),phase histogram bandwidth,skewness and kurtosis.Results The history of occlusion for the 21 patients ranged from 3 to 60 months.In all CTO patients,the phase SD and bandwidth were higher than the healthy reference values:((30.8±28.3)°vs (14.2±5.1)°,t=3.09; (58.1±39.4)° vs (38.7±11.8)°,t=2.61,both P＜0.05).LVEF was negatively correlated with the phase SD and bandwidth (r=-0.785,-0.883,both P＜0.01) but positively correlated with phase histogram skewness and kurtosis (r=0.755,0.666,both P＜0.01).Higher LVEF value was shown in normal group than that in group((69.3±4.7)％ vs (44.7±13.0)％,t=-5.65,P＜ 0.01).The perfusion deficit in normal group (4.0％) was lower than that in abnormal group (16.0％) (Z=-2.23,P＜0.05) while the metabolic deficit of the two groups was similar (Z=-1.82,P＞0.05).The phase SD and bandwidth were lower in normal group than those in abnormal group ((18.7±19.0)° vs (44.2± 31.6)°,t=2.21; (36.4±12.7)° vs (82.1±45.4)°,t=3.08,both P＜0.05) and skewness and kurosis were higher in normal group than those in abnormal group (5.11 ± 0.75 vs 3.55 ± 1.05,t =-3.89 ; 30.77± 10.49 vs 15.66±10.12,t=-3.35,both P＜0.01).Conclusions The left ventricle synchrony was significantly worse in patients with CTO than that in normal individuals.The phase histogram could be used to estimate the the contractile function of left ventricle in the patients with CTO.