[1]姚立新,刘彬彬.门控心肌灌注显像局部室壁运动异常判断冠状动脉狭窄程度的价值[J].国际放射医学核医学杂志,2007,31(2):90-93.
　YAO Li-xin,LIU Bin-bin.The value of regional wall motion abnormalities on gated mycardiac perfusion imaging in predicting angiographic stenoses of coronary artery[J].International Journal of Radiation Medicine and Nuclear Medicine,2007,31(2):90-93.
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门控心肌灌注显像局部室壁运动异常判断冠状动脉狭窄程度的价值(/HTML)
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
31
期数:
2007年第2期
页码:
90-93
栏目:
临床核医学
出版日期:
1900-01-01

文章信息/Info

Title:
The value of regional wall motion abnormalities on gated mycardiac perfusion imaging in predicting angiographic stenoses of coronary artery
作者:
姚立新1;  刘彬彬2
1. 066000 秦皇岛, 秦皇岛市第一医院核医学科;
2. 066000 秦皇岛, 秦皇岛市第一医院功能科
Author(s):
YAO Li-xin1;  LIU Bin-bin2
1. Department of NuclearMedicine, The First Hospital of Qinhuangdao, Qin-huangdao 066000, China;
2. Department of Fuction, The First Hospital of Qinhuangdao, Qin-huangdao 066000, China
关键词:
冠状动脉狭窄; 潘生丁; 99m锝甲氧基异丁基异腈; 体层摄影术; 发射型计算机; 单光子
Keywords:
Coronary stenosis; Dipyridamole; Technetium 99m sestamibi; Tomograghy; emission computed; single photon
分类号:
R817.4
摘要:
目的 探讨99mTc-甲氧基异丁基异腈(99mTc-MIBI)门控心肌灌注显像出现的可逆性局部室壁运动异常(RWMA)在判断冠状动脉狭窄程度中的价值。方法 入选90例疑似冠心病患者,在门控心肌灌注显像的前后2周内进行冠状动脉造影检查。门控心肌SPECT检查应用9节段5分制进行室壁运动及增厚率评分。结果 心肌显像上可逆性RWMA判断≥75%的冠状动脉狭窄的灵敏度为64%,特异度为95%;用可逆性RWMA来区别严重冠状动脉狭窄(≥75%)和不严重的冠状动脉狭窄(<75%)有很高的阳性预测值(97%)。可逆性RWMA和濒危冠状动脉评分之间有良好的相关性。多因素分析显示,负荷室壁负荷总积分、室壁负荷差分值和心电图负荷试验阳性是濒危冠状动脉积分的独立危险因子。结论 根据99mTc-MIBI门控心肌灌注显像上可逆性RWMA判断严重冠状动脉狭窄具有高度的特异性和阳性预测值。潘生丁负荷后及可逆性RWMA增强了心肌灌注显像对冠状动脉狭窄程度的评估。
Abstract:
Objective To determine the possible level of angiographic stenoses of coronary artery at which reversible regional wall motion abnormalities (RWMA) are present on 99mTc-sestamibi (99mTc-MIBI)-gated myocardial perfusion imaging (MPI). Methods ninty patients undergoing coronary angiography MPI within two weeks were recruited. A five grades and nine segments marking system was introduced to assess the RWMA and thickening of left ventricles. Results The sensitivity of reversible RWMA for detecting ≥75% angiographic stenoses was 64%,with a specificity of 95% and positive predictive value of 97%.The presence of reversible RWMA was able to stratify patients with severe angiographic stenoses of 75% or more from those less than 75% with high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score. Multivariate analysis showed that the post-stress RWMA and reversible RWMA scores and positive dipyridamole-stress exercise electrocardiogram(ECG) were significant predictors of angiographic severity. Conclusions Reversible RWMA, as shown by dipyridamole stress 99mTc-MIBI MPI, is a significant predictor of angiographic disease with very high specificity and adds incremental value to MPI for the assessment of angiographic severity.

参考文献/References:

1 Kloner RA, Arimie RB, Kay GL, et al. Evidence for stunned myocardium in humans:a 2001 update. Coro Art Dis, 2001,12(5):349-355.
2 Ambrosio G, Betocchi S, Pace L, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina:evidence of myocardial stunning in patients with coronary artery disease. Circulation, 1996, 94(10):2455-2464.
3 Johnson LL, Verdesca SA, Aude WY, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. Am Coll Cardiol, 1997, 30(7):1641-1648.
4 Berman DS, Hayes SW, Shaw LJ, et al. Recent advances in myocardial perfusion imaging. Curr Pro Cardiol, 2001, 26(1):8-12.
5 Califf RM, Phillips HR 3rd, Hindman MC, et al. Prognostic value of a coronary artery jeopardy score. J Am Coll Cardiol, 1985, 5(5):1055-1063.
6 Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death:differential stratification for risk of cardiac death and myocardial infarcton.Circulation, 1998, 97(6):535-543.
7 Emmett L, Iwanochko RM, Freeman MR,, et al. Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses. J Am Coll Cardiol, 2002, 39(6):991-998.

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备注/Memo

备注/Memo:
收稿日期:2006-11-07。
通讯作者:姚立新(E-mail:yaolixin158@sina.com)
更新日期/Last Update: 1900-01-01