[1]周凡 汪建强 陈春梦 黄静.ATP负荷99mTc-MIBI 门控SPECT/CT心肌灌注显像在心脏X综合征的诊治应用[J].心血管病学进展,2020,(9):989-993.[doi:10.16806/j.cnki.issn.1004-3934.2020.09.024]
　ZHOU Fan,WANG Jianqiang,CHEN Chunmeng,et al.Application of ATP Stress 99mTc-MIBI Gated SPECT/CT Myocardial Perfusion Imaging in Diagnosis and Treatment of Cardiac Syndrome X[J].Advances in Cardiovascular Diseases,2020,(9):989-993.[doi:10.16806/j.cnki.issn.1004-3934.2020.09.024]
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ATP负荷99mTc-MIBI 门控SPECT/CT心肌灌注显像在心脏X综合征的诊治应用()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2020年9期
页码:
989-993
栏目:
出版日期:
2020-09-25

文章信息/Info

Title:
Application of ATP Stress 99mTc-MIBI Gated SPECT/CT Myocardial Perfusion Imaging in Diagnosis and Treatment of Cardiac Syndrome X
作者:
周凡1 汪建强 1 陈春梦1 黄静2
（1.宜宾市第二人民医院核医学科 四川大学华西医院宜宾医院,四川 宜宾 644000 2. 宜宾市第二人民医院超声科 四川大学华西医院宜宾医院,四川 宜宾 644000 )
Author(s):
ZHOU Fan 1 ;  WANG Jianqiang 1 ;  CHEN Chunmeng 1 ;  HUANG Jing 2
(1.Department of Nuclear Medicine,The Second Peoples Hospital of Yibin, Yibin Hospital Affiliated to West China Hospital of Sichuan University, Yibin 644000,Sichuan,China 2.Department of Ultrasound,The Second Peoples Hospital of Yibin,Yibin Hospital Affiliated to West China Hospital of Sichuan University, Yibin 644000,Sichuan,China)
关键词:
三磷酸腺苷; 99mTc-MIBI; 门控心肌灌注显像
Keywords:
Adenosine triphosphate;  99mTc-MIBI;  Gated myocardial perfusion imaging
DOI:
10.16806/j.cnki.issn.1004-3934.2020.09.024
摘要:
目的 探讨心脏X综合征（CSX）患者心肌缺血临床诊治中ATP负荷99mTc-MIBI 门控SPECT/CT心肌灌注显像所发挥的临床作用。方法 回顾本院临床诊断CSX 56例，采用ATP负荷/静息门控SPECT/CT心肌灌注显像方法，对左心室心肌短轴和长轴图像进行17节段划分判断心肌缺血部位，应用半定量（0～3分）法判断心肌缺血程度，将左心室射血分数（LVEF）同超声心动图的测值进行比较，同时对患者进行至少1年的随访。结果 ATP负荷99mTc-MIBI 门控SPECT/CT心肌灌注显像判断心肌缺血者48例，冠状动脉左前降支、左回旋支和右冠状动脉关联区域放射性分布异常节段分别为210个（62.5%）、101个（42.1%）和93个（38.8%），左前降支关联区域核素分布异常节段数高于左回旋支（P<0.05）和右冠状动脉（P<0.05）；轻度缺血36例（75.0%），中度缺血10例（20.8%），重度缺血2例（4.2%）。静息状态下测得LVEF（65.59±3.13）%与超声心动图测得LVEF（64.22±3.12）%比较，二者差异无统计学意义（P>0.05）。随访39例心肌缺血患者，无心脏事件发生，心肌缺血症状明显好转。结论 ATP负荷99mTc-MIBI 门控SPECT/CT心肌灌注显像能准确地判断CSX患者心肌缺血部位、程度及左心功能，对临床医师治疗决策具有指导价值。
Abstract:
Objective To investigate the clinical effect of ATP Stress 99mTc-MIBI gated SPECT/CT myocardial perfusion imaging (SPECT/CT-G-MPI) in the clinical diagnosis and treatment of myocardial ischemia in cardiac syndrome X patients . Methods A total of 56 patients with cardiac syndrome X clinically diagnosed in our hospital were reviewed. The short and long axis images of left ventricular myocardium were divided into 17 segments using ATP-loaded/resting-state SPECT/CT-G-MPI. The degree of myocardial ischemia was evaluated by semi-quantitative (0 ～3 points ) method , and the left ventricular ejection fraction (LVEF) was compared with that of echocardiography. In addition,the patients were followed up for at least 1 year. Results ATP Stress 99mTc-MIBI SPECT/CT-G-MPI detected myocardial ischemia in 48 patients. The abnormal radioactive distribution of left anterior descending branch,left circumflex branch and right coronary artery were 210(62.5%), 101(42.1%) and 93(38.8%), respectively .The number of abnormal nuclide distribution in the left anterior descending branch was higher than that in the left circumflex branch ( P < 0.05) and the right coronary artery ( P < 0.05). There were 36 patients(75.0%) with mild ischemia, 10 patients(20.8%) with moderate ischemia, and 2 patients(4.2%) with severe ischemia. No statistically significant difference was found between LVEF [(65.59 ± 3.13)% ] measured in the resting state and LVEF [(64.22 ± 3.12)% ] by echocardiography( P>0.05). Follow-up of 39 patients with myocardial ischemia showed that no cardiac events occurred, and the symptoms of myocardial ischemia were significantly improved. Conclusion ATP Stress 99mTc-MIBI SPECT/CT-G-MP can accurately determine the location, degree and left ventricu lar function of myocardial ischemia in CSX patents, and has guiding value for clinicians to make treatment decision.

参考文献/References:

[1]Mygind ND,Michelsen MM,Pena A,et al.Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease:the iPOWER study[J]. J Cardiovasc Magn Reson,2016,18(1):76.

[2]Pepine CJ,Anderson RD,Sharaf BL,et al.Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected is chemia:results from the NHLBI Women’s Ischemia Syndrome Evaluation(WISE)[J]. J Am Coll Cardiol,2010,55(25):2825-2832.

[3]钟仕利,黄晶.女性冠状动脉微血管性心绞痛的诊断及治疗进展[J].心血管病学进展,2019,40(7):992-995.

[4]黄钢,石洪成.心脏核医学[M].上海:上海科学技术出版社,2011:76-79。

[5]Lanza GA,Crea F. Primary coronary microvascular dysfunction:clinical presentatio n,pathophysiology and management[J]. Circulation,2010,121(21):2317-2325.

[6]Kaski JC,Elliott PM. Angina pectotis and normal coronary arteriograms:clinical presentation and hemodynamic characteristics[J]. Am J Cardiol,1995,76(4):35D-42D.

[7]Kamlesh K,Bairay Meiz CN. Microvascular coronary dysfunction in women:pathophysiology,diagnosis,and management[J].Curr Probl Cardiol,2011,36(8):291-318.

[8]Schepis T,Benz K,Haldemann A,el al. Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging:risk stratification of patients with much vessel coronary artery disease and prior coronary revascularization[J]. J Nucl Cardiol,2013,20(5):755-762．

[9]潘靖,王颖等. 三磷酸腺苷负荷99m锝-甲氧基异丁基异腈门控心肌灌注显像在评价X综合症中的价值[J].中国循环杂志,2014,29(5):331-334.

[10] Hsu TH,Huang WS,Chen CC,et al. Left ventricular systolic and diastolic dyssynchrony assessed by phase analysis of gated SPECT myocardial perfusion imaging:a comparison with speckle tracking echocardiography[J]. Ann Nucl Med,2013,27(8):764-771.

[11]Wang Y,Qin L,Shi X,et al. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT:comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging[J]. AJR Am J Roentgenol,2012,198(3):521-529.

[12]Varga-Szemes A,Meinel FG,de Cecco CN,et al. CT myocardial perfusion imaging[J]. AJR Am J Roentgenol,2015,204(3):487-497.

[13]George RT,Arbab-Zadeh A,Miller JM,et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease[J].Circ Cardiovasc Imaging,2012,5(3):333-340.

[14]Saeed M,Van TA,Krug R,et al.Cardiac MR imaging:currentstatus and future direction[J]. Cardiovasc Diagn Ther ,2015,5(4):290-310.

[15]Durante A,Laricchia A,Benedetti G,et al.Identification of high-risk patients after ST-segment-elevation myocardial infarction:comparison between angiographic and magnetic resonance parameters[J].Circ Cardiovasc Imaging,2017,10(6):e005841.

[16]Karamitsos TD,DallArmellina E,Choudhury RP,et al. Ischemic heart disease:comprehensive evaluation by cardiovascular magnetic resonance[J]. Am Heart J,2011,162(1):16-30.

[17]Kaski JC,Aldama G,Cosín-Sales J.Cardiac syndrome X.Diagnosis,pathogenesis and management[J].Am J Cardiovasc Drugs,2004,4(3):179-194.

备注/Memo

备注/Memo:
通信作者：周凡，E-mail：www.495000324@qq.com 收稿日期：2020-02-16
更新日期/Last Update: 2020-12-04