二硝酸异山梨酯介入99mTc-MIBI心肌显像对梗死后存活心肌的判定及比较

目的:评价二硝酸异山梨酯(Isoket)介入99mTc-甲氧基异丁基异腈(MIBI)心肌断层显像检测心肌梗死后存活心肌的价值,并观察99mTc-MIBI心肌显像评价急性心肌梗死(AMI)与陈旧性心肌梗死(OMI)存活心肌的差异.方法:对16例OMI患者和12例AMI患者,分别进行静息99mTc-MIBI显像和Isoket静脉介入后99mTc-MIBI心肌断层显像.结果:静息99mTc-MIBI显像出现灌注异常185个节段,根据心肌放射性分布情况打分,平均得分为15.1±3.8,Isoket介入99mTc-MIBI显像后出现灌注异常节段为160个,平均得分为10.8±1.6,两者比较差别有显著性(P＜0.01).静息99mTc-MIBI显像出现的185个灌注异常的节段中16例OMI占102个,12例AMI占83个;Isoket介入后87个得到不同程度改善的节段中OMI占40个,AMI占47个,两者比较,P＜0.05.结论:Isoket介入99mTc-MIBI显像与静息99mTc-MIBI显像比较可明显提高对存活心肌检测的灵敏度,并对AMI存活心肌的检出率要明显高于OMI.     

易化PCI对急性心肌梗死面积及心功能的影响

目的探讨易化经皮冠状动脉介入(PCI)治疗对急性心肌梗死(AMI)患者心肌梗死面积和心功能的影响. 方法 114例首次AMI患者发病时间均在12 h以内,其中46例接受易化PCI治疗, 68例接受直接PCI治疗,并于PCI术后1个月时行99mTc-MIBI核素心肌灌注显像和平衡法心血池显像检查,分别测定心肌梗死面积和心功能,比较易化PCI和直接PCI治疗对AMI患者心肌梗死面积和心功能的影响. 结果 PCI术后1个月时易化PCI组平均心肌梗死面积明显小于直接PCI组,心功能明显好于直接PCI组.结论易化PCI治疗AMI安全有效,早期再通率高,心肌梗死面积小,更有利于保护心室功能.     

043 急性心肌梗死后的危险分级中核素灌注显像的价值

在急性心肌梗死(AMI)患者中,放射性核素技术在临床确定梗死面积、评估再灌注后心肌存活数量、确定静息性协同不能的梗死区域心肌活力、检测运动或药物应激时梗死区内或其周围诱发的心肌缺血等方面起着较大的作用.AMI患者出院前的应激闪烁图显示的高危险心肌灌注图像:(1)梗死区内的可逆性缺损;(2)扫描图像显示多支冠脉病变;(3)与大面积梗死一致的大的非可逆性缺损;(4)从应激至静息时的显像存在暂时性左室腔扩大;(5)应用示踪剂时,肺吸收201铊(201Tl)增多;(6)门电路单光子发射性计算机断层显像(SPECT) 示静息左室射血分数<40%.Shaw等对MI后运动应激心肌灌注显像患者的研究显示,应激诱发可逆性缺损显像者的死亡率为7.1%,而无诱发可逆性缺损显像者的死亡率仅为1.6%.同样,在>1支冠脉供血区域存在多处缺损者的死亡率和MI率为16.7%.而扫描正常者的死亡率和MI率仅为2%.Gibson等对无并发症的MI患者于出院前采用次极量运动201Tl闪烁图证实,无并发症而扫描显示高危险的MI者约50%后来发生心脏事件.扫描时梗死区域存在非可逆性缺损的低危险者的心脏事件率仅为6%. Dakik等报道,MI后溶栓治疗者进行运动应激定量201Tl SPECT显像对预测预后有重要价值,而冠脉造影预测预后的价值则与临床表现、左室射血分数和201Tl SPECT显像相仿.左室缺损<20%者后来的心脏事件率极低,根据定量显像结果分成高、低危险组与冠脉造影的危险分组效果相仿,即单支冠脉病变的为低危险者、多支冠脉病变的为高危险者. 急性MI后危险分级中,运动或药物99mTc-sestamibi(99mTc-MIBI)显像的效果与201Tl闪烁图相仿.Travin等报道,99mTc-MIBI SPECT显像显示存在缺血或多支冠脉供血范围出现缺损者出院后92%发生心脏事件.临床、ECG应激试验和99mTc-MIBI SPECT显像显示缺血性缺损数目的Cox回归分析发现,仅心脏事件率为38%且99mTc-MIBI SPECT显像显示>3个可逆性缺损的患者与后来的心脏事件率明显相关.无明显并发症的MI者可早期进行扩血管药物显像.Brown等的研究显示,梗死区域的201Tl再分布结果仅是住院期间或出院后心脏事件的重要预报因子.201Tl闪烁图显示缺血者住院期间缺血性心脏事件率为45%.急性MI住院后2～4d进行潘生丁99mTc-MIBI大型多中心试验显示,潘生丁99mTc-MIBI SPECT显像显示低危险者2年的心脏事件率仅为2%/年. 大量证据提示,无并发症的急性MI者出院前早期进行运动或药物应激心肌灌注显像可将患者分为高、低危险者.入院后2～3d进行药物应激心肌灌注显像较为安全,并为预测预后提供重要依据. (陈清江施文兴摘)     

腺苷负荷心肌灌注显像对冠状动脉介入治疗的临床意义

目的:探讨腺苷负荷心肌灌注显像对冠状动脉(冠脉)介入治疗的临床意义。方法:66例冠心病患者,行腺苷负荷心肌灌注显像和冠脉造影,根据需要进行介入治疗,介入治疗后3～7天复查腺苷负荷心肌灌注显像。腺苷负荷心肌灌注显像采用单光子发射断层显像图像采集系统,腺苷注射液总量为840μg/kg,6分钟匀速静脉泵入,腺苷泵入3分钟时静脉推注99锝-2-甲氧基异丁基异腈核素(99mTc-MIBI);1.5h后进行心肌灌注断层显像。若异常,次日行静息心肌显像。核素显像左心室心肌分为9个节段,心肌灌注评分分4级。结果:66例患者的腺苷负荷心肌灌注显像与冠脉造影结果相比,双支病变腺苷负荷心肌灌注显像阳性率(87.5%,28/32)和三支病变腺苷负荷心肌灌注显像阳性率(100%),与冠脉造影阳性率(100%)比较差异均无统计学意义(P0.05);单支病变腺苷负荷心肌灌注显像阳性率为54.5%(12/22),与冠脉造影阳性率(100%)比较差异有统计学意义(P0.01)。双支病变和三支病变腺苷负荷心肌灌注显像阳性率分别与单支病变相比,差异均有统计学意义(P均0.05)。冠脉介入后心肌核素显像血流灌注改善率为94.1%(32/34),与冠状动脉介入前(0%,0/34)自身对照,差异有统计学意义(P=0.003)。结论:腺苷负荷心肌灌注显像对于冠心病患者冠脉介入前病变程度分析以及介入后疗效判断有一定的临床意义。     

选择性冠状动脉99mTc-MIBI介入心肌灌注显像评价心肌梗死后存活心肌的实验研究

目的 探讨选择性冠状动脉99mTc-MIBI介入心肌灌注显像检测心肌梗死后存活心肌的价值。方法 以犬的实验性心肌梗死模型为研究对象,采用自身对照方法,先后行99mTc-MIBI静息心肌灌注显像、硝酸甘油(NTG)静滴99mTc-MIBI。心肌灌注显像和选择性冠状动脉99mTc-MIBI介入心肌灌注显像,采用四点计分法对各节段核素分布进行半定量评价。结果 与NTG静息心肌灌注显像比较,选择性冠状动脉99mTc-MIBI介入心肌灌注显像对心肌梗死后存活心肌有更高的检出率[(5.1±1.5)vs(6.3±1.4)分,P<0.05]。结论 选择性冠状动脉99mTc-MIBI介入心肌灌注显像诊断存活心肌,具有准确、快速、可与冠状动脉造影同步的优点,具有实用价值。     

心肌灌注断层显像对急性心肌梗死再灌注的研究

目的　通过心肌灌注断层显像研究急性心肌梗死 (AMI)患者经尿激酶或冠状动脉介入治疗前后心肌梗死面积的变化。方法　用99m锝甲氧基异丁基异腈心肌灌注断层显像测定 12 0例AMI患者心肌再灌注前后的心肌梗死面积。结果　再灌注组 (n =81)和无再灌注组 (n =36 )首次心肌显像心肌缺损面积无显著性差异 (P >0 0 5 ) :再灌注组再次显像心肌缺损面积明显小于首次显像 (2 2 3± 3 1%和 31 9± 5 6 % ,P <0 0 5 ) ;无再灌注组再次显像心肌缺损面积与首次显像无明显差异 (2 9 6± 2 8%和 32 4± 5 l% ,P >0 0 5 ) ;预后不良组心肌缺损面积明显高于预后较好组 (35 8± 6 1% ,n =32和2 0 6± 4 0 % ,n =88,P <0 0 5 )。结论　心肌灌注断层显像可作为AMI再灌注疗效评价较准确的手段     

运动试验99mTc-MIBI心肌灌注断层显像诊断冠心病的临床评价

目的评价运动试验99mTc-MIBI心肌灌注断层显像对冠心病的诊断价值。方法对160例病人同时进行冠状动脉造影及运动试验99mTc-MIBI心肌断层显像。结果运动试验99mTc-MIBI心肌断层显像诊断冠心病的敏感性为91.1%,特异性为87.5%。对冠状动脉单支、双支、三支病变组病人诊断的敏感性分别为83.3%、93.8%和100.0%。结论运动试验99mTc-MIBI心肌断层显像对判断心肌缺血有较高的临床应用价值。     

045 运动性核素心肌灌注显像诊断冠心病研究进展

运动性核素心肌灌注显像在检测冠心病、评价心脏病变程度等方面已取得许多进展,现摘要概述如下. 定量单光子发射型计算机断层显像(SPECT)是心肌灌注显像的重要进展.有研究以SPECT检查1 447例冠心病(CAD)患者,其敏感性平均为92%(82%～98%)、特异性为68%(44%～91%).SPECT检测CAD的特异性低的原因,可能与扫描异常者做冠脉造影检查比扫描正常者多有关.饶有兴趣的是,SPECT检测既往无心肌梗死者CAD的敏感性仍高达85%.SPECT201铊(201Tl)显像检测1支、2支和3支冠脉病变的敏感性分别平均为83%、93%和95%.使SPECT201Tl显像检测CAD敏感性降低的主要因素有1支冠脉病变、左旋支狭窄、冠脉分支或远端狭窄、内径狭窄50%～70%的轻度冠脉狭窄、由非心脏症状所致停止运动时的不适当心率反应、应用硝酸盐类或钙通道阻滞剂治疗的心绞痛等.因此,应提高检测既往有心肌梗死、广泛性冠脉病变、高度冠脉狭窄、近端冠脉狭窄、局部室壁运动异常患者的敏感性.在这方面,定量扫描分析的敏感性和特异性要比应激试验和再分布201Tl闪烁图视觉评价的敏感性高. 由于201Tl闪烁法不能识别假稀疏图像,故其总敏感性并不十分理想.虽然定量201Tl显像的敏感性有所提高,但假阳性率仍然较高.在心尖部到心底部常观察到假阳性缺损.女性由于乳房组织的覆盖,前壁和室间隔等部位可出现假稀疏图像.高位横膈可造成下壁假阳性缺损.门电路99m锝(99mTc)灌注显像,可在断层X线照相SPECT上评价从舒张末期至收缩末期的收缩期室壁厚度.识别低灌注区域正常的收缩期室壁厚度,并可确定缺损是假稀疏而不是心肌疤痕.以门电路断层X线照相评价时,后者最可能伴有收缩期室壁厚度变小.Taillefer等的前瞻性研究评价了201Tl和99mTc灌注显像检测女性CAD的准确性.该研究中许多患者做过冠脉造影,检测明显CAD的总敏感性201Tl和99mTc相仿.然而,201Tl或99mTc-sestamibi(99mTc-MIBI)灌注显像、门电路99mTc-MIBI SPECT显像检测冠脉内径狭窄≥50%者的特异性分别平均为70.6%、86.3%和94.1%(P=0.05、P=0.002);检测冠脉内径狭窄≥70%者的特异性分别平均为67.2%、84.4%和92.2%.201Tl的特异性显著低于99mTc-MIBI和门电路99mTc-MIBI(P=0.02、P=0.0004),99mTc-MIBI灌注显像和门电路99mTc-MIBI SPECT显像两者间则无显著差异. 对运动性99mTc-MIBI SPECT显像研究的集中分析表明,99mTc-MIBI和201Tl检测CAD的敏感性分别为90%和83%,特异性分别为93%和80%,正常化比率99mTc-MIBI为100%、201Tl为77%.静息201Tl/应激99mTc-MIBI SPECT显像双重同位素检查,可从非可逆性缺损中识别可逆性缺损.该方案于静息时注射3.5mCi201Tl,10min后获得显像;获得这些静息性显像后立即进行运动试验,于运动高峰时注射25～30mCi99mTc-MIBI.Berman等报道这一方法检测CAD的敏感性和特异性分别为91%和75%.预试验时CAD可能性低者的正常化比率为95%.静息性201Tl/ 99mTc-MIBI闪烁图的可逆行缺损检出率与标准静息性201Tl/ 99mTc-MIBI SPECT显像相仿.最近的研究显示,新型99mTc标记灌注剂99mTc-N-NOET,首次通过心肌摄取指数比99mTc-MIBI或99mTc-tatrofosmin高,分布时间与201Tl相仿. (陈清江摘)     

99mTc-MIBI门电路SPECT对冠心病的诊断和心肌存活性评价的作用

为进一步评价99m锝-甲氧基异睛(99mTc-MIBI)门电路和非门电路单光子发射断层显像(SPECT)对冠心病的诊断价值及硝酸甘油介入诊断试验在心肌存活状态评价中的作用,对40例进行运动心肌灌注断层显象,并与冠状动脉(冠脉)造影比较.结果32例冠脉造影显示冠脉有意义狭窄.门电路断层显象对冠心病诊断总的敏感和特异性分别为93.8%和87.5%;非门电路断层显象分别为84.4%和87.5%,两相比较,无显著性差异(P＞0.05).对冠脉病变支数诊断敏感性门电路方法优于非门电路方法(分别为73.8%和62.3%,P＜0.05).特异性均为96.6%.20例进行含服硝酸甘油后静态心肌灌注断层显象,16例心肌梗死病人中有3例为部分可逆性心肌灌注缺损,4例慢性心肌缺血病人,全部有可逆性心肌灌注.表明硝酸甘油介入诊断试验有助于心肌灌注异常可逆性的评估;99mTc-MIBI门电路SPECT和硝酸甘油介入诊断试验是有效的对冠心病无创性诊断和心肌存活状态评价方法.     

046 应激性核素灌注显像预测冠心病预后的价值

临床研究评价数千例冠心病(CAD)患者后,确立了运动和药物应激灌注显像预测冠心病预后的价值.在未确诊的胸痛患者或已确诊的CAD患者中,应激灌注显像无创伤性危险分级的主要目的是识别心脏性死亡或非致命性心肌梗死(MI)的高危险亚组,以便及时进行创伤性检查.相反,闪烁图结果显示将来发生心脏事件危险较小的患者可免于不必要的创伤性检查. 应激灌注显像预测将来心脏事件的主要预后变量是左室>20%的缺损、提示多支冠脉病变的>1支冠脉供血区域缺损、多个心肌扫描段缺血诱发的可逆性缺损、1支冠脉供血区域的大量不可逆性缺损、从应激时至静息时存在暂时性和持续性左室扩大、201铊(201Tl)闪烁图示肺部吸收201Tl增多及99m锝(99mTc)门电路单光子发射型计算机断层显像(SPECT)测得静息时左室射血分数<40%者.201Tl或99mTc标记剂的运动或药物应激灌注显像最有价值的特征之一,是在扫描完全正常者中预示死亡率和MI率的良好阴性预测值.应激峰值扫描正常者,年死亡率和非致命性MI率<1%. 有报道显示,应激性99mTc-sestamibi(99mTc MIBI)心肌灌注显像的预后价值与201Tl显像相仿.Iskander等分析了14个预后研究的12 000多例患者的灌注显像资料的预后价值.在这些患者中,应激性SPECT99mTc-MIBI显像正常者和异常者的平均年危险事件率分别为0.6%和7.4%,后者为前者的12倍.Hachamovtch等的研究显示,834例运动试验后Duke踏车分数中等但99mTc-MIBI应激灌注扫描正常者,年死亡率和MI率仅为0.4%,而扫描异常者的心脏性死亡率和非致命性MI率则高达8.9%.该研究中运动99mTc-MIBI灌注显像结果提供的预后价值女性要比男性大.Marwick等研究显示3支主要冠脉供血范围的缺损数目与死亡率强相关.踏车运动时,运动耐力良好者预后亦佳.Chatziioannou等对388例运动心肌灌注扫描正常者或异常者采用Cox危险比率回归分析提示,心肌灌注显像是心脏事件的最佳预报因子(相对危险=8,P<0.001),但运动心电图结果或Duke踏车分数不能预测心脏事件. 应激后99mTc-MIBI图像显示的低灌注程度可成为选择内科治疗或血管重建的依据.判定为无高危险的轻度可逆性灌注缺损患者最常可能选择内科治疗,而SPECT图像显示高危险可逆性缺损者则应进一步做创伤性检查.Hachamovitch等也发现,应激灌注扫描轻度异常者中,内科治疗或血管重建者的年心脏死亡率分别为0.8%和0.9%.轻度、中度扫描异常者的年心脏死亡率,血管重建者分别为1.1%和1.3%、内科治疗者分别为2.3%和4.6%.该研究结果表明,轻度或中度扫描异常者血管重建术降低年心脏死亡率的效果显著优于内科治疗者(P<0.001). 上述研究资料表明,心肌灌注扫描正常者预后良好,即使冠脉造影确诊的CAD亦然.随访期间,扫描异常者的心脏性死亡率和非致命MI率增加.应激诱发低灌注程度较重者和可逆性缺损较大者易于发生心脏事件.如果存在缺血性左室扩大或肺吸收201Tl增加,则任何程度低灌注的心脏事件率都很高.应激性SPECT显像结果正常或有小的非可逆行缺损者,宜选择预防措施;轻度可逆行缺损者可采取内科治疗和定期显像检查;存在多个缺损的高危险者应及早做血管重建手术. (施文兴陈清江摘)     

急性心肌梗死急诊经皮冠状动脉介入治疗后评价心肌组织再灌注方法的对比研究

目的应用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度和超声心动图四种方法评价急性心肌梗死急诊经皮冠状动脉介入治疗后心肌水平再灌注。方法50例急性心肌梗死患者急诊介入治疗后采用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度及随访1个月超声心动图观察室壁运动改善四种方法评价心肌灌注,并于术后7±2天行核素心肌灌注显像。结果与核素心肌灌注显像比较,TIMI心肌灌注分级敏感性为94.7,特异性为16.7,准确性为76.0;单个导联ST段回落幅度敏感性为89.5,特异性为83.3,准确性为88.0;单个导联ST段最大偏移幅度敏感性为84.2,特异性为83.3,准确性为84.0;超声心动图敏感性为78.9,特异性为83.3,准确性为80.0。心电图(单个导联ST段回落幅度、单个导联ST段最大偏移幅度)和超声心动图与核素检查存在一致性,且一致性良好;TIMI心肌灌注分级未显示与核素检查存在一致性。结论心电图和超声心动图可较好地评价急性心肌梗死后心肌组织再灌注水平。     

99mTc-MIBI心肌灌注断层显像与心电图对冠心病的诊断价值

目的评估^99mTc—MIBI心肌灌注断层显像与心电图（ECG）在冠心病（CAD）诊断的价值。方法对28例冠心病和可疑冠心病患者进行心电图检查和^99mTc—MIBI心肌灌注断层显像（同时采用半定量方法分析患者左心室心肌血流灌注情况），其中13例患者行冠状动脉造影术（CAG）。结果心肌灌注断层显像与ECG阳性率分别为42．9％、53．6％，两者阳性率间差异无显著性意义（P〉0．05）。ECG诊断冠心病的敏感性为3／3，特异性为3／10，阳性预测值为3／10，阴性预测值为3／3，准确度为6／13。心肌灌注显像诊断冠心病的敏感性为3／3，特异性为8／10，阳性预测值为3／5，阴性预测值为8／8，准确度为11／13。心肌灌注断层显像和ECG与CAG阳性率间差异均无显著性意义（P〉0．05）。结论^99mTc—MIBI心肌灌注层显像与心电图是安全、无创伤、方便及费用低的检查方法，临床联合应用对冠心病的诊断、治疗和预后判断有重要的价值。     

Quantification of area at risk during coronary occlusion and degree of myocardial salvage after reperfusion with technetium-99m methoxyisobutyl isonitrile

Serial myocardial imaging with technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI) has been proposed for evaluating myocardial salvage after reperfusion. To define 99mTc-MIBI uptake before and after reperfusion, 17 open-chest dogs underwent 3 hours of left anterior descending artery occlusion and 3 hours of reperfusion. 99mTc-MIBI was injected during occlusion (group 1) or after 90 minutes of reperfusion (group 2). Myocardial 99mTc-MIBI activity was correlated with microsphere flow during occlusion and reperfusion. Anatomic risk area and infarct area were defined by postmortem vital staining and correlated with the perfusion defects defined by analysis of 99mTc-MIBI macroautoradiographs and gamma camera images of myocardial slices. The left ventricle was divided into 96 segments for gamma well counting. Flow and 99mTc-MIBI activity were normalized to nonischemic values. Myocardial segments were grouped, based on occlusion flow, into zones: severely ischemic (less than or equal to 30% nonischemic), moderately ischemic (greater than 30%, less than or equal to 60% nonischemic), mildly ischemic (greater than 60%, less than or equal to 90% nonischemic), and nonischemic (greater than 90%, less than or equal to 120% nonischemic). Among dogs injected with 99mTc-MIBI during coronary occlusion (group 1), myocardial 99mTc-MIBI activity correlated linearly with occlusion flow for both endocardial (r = 0.91) and transmural (r = 0.91) segments. The risk area defined by 99mTc-MIBI autoradiography (group 1) correlated with the postmortem risk area (rho = 0.94) but was 29% smaller than the anatomic risk area (p = 0.03), reflecting the contribution of collateral flow. Among dogs injected with 99mTc-MIBI after reperfusion (group 2), myocardial 99mTc-MIBI did not correlate with reperfusion flow in either endocardial or transmural segments. Among group 2 dogs, myocardial 99mTc-MIBI activity was significantly less than reperfusion flow at the time of injection in the severely ischemic (25 +/- 5% versus 74 +/- 24% nonischemic, p = 0.002), moderately ischemic (54 +/- 12% versus 96 +/- 15% nonischemic, p = 0.001), and mildly ischemic (84 +/- 6% versus 93 +/- 3% nonischemic, p = 0.002) zones. The defect area defined by 99mTc-MIBI autoradiography (group 2) correlated very closely with the postmortem infarct area (rho = 0.98). Thus, the myocardial uptake of 99mTc-MIBI during coronary occlusion correlates with occlusion flow and reflects the "area at risk." When 99mTc-MIBI was given after 90 minutes of reperfusion following 3 hours of coronary occlusion, the myocardial activity was significantly reduced compared with reperfusion flow in both necrotic and perinecrotic regions, reflecting myocardial viability more than the degree of reperfusion.     

急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP CTFC、TMP sumSTR、CTFC sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP sumSTR、TMP CTFC能更好的评价心肌灌注程度 ;TMP sumSTR可预测 6个月心脏事件。     

CABG联合自体干细胞移植治疗心肌梗死疗效观察

目的观察冠脉搭桥术（CABG）联合经冠状动脉桥血管及心外膜下注入自体外周血干细胞治疗心肌梗死的疗效。方法 32例冠心病心肌梗死患者,随机分为对照组和观察组,各16例。观察组术前5 d使用重组人粒细胞集落刺激因子皮下注射进行外周血干细胞（PBSC）的动员及扩增。CABG术前24 h进行PBSC的采集和浓缩。两组均在非体外循环下行CABG,观察组在完成血管桥吻合后,经桥血管及心外膜下注入PBSC。术前1周及术后3、6个月采用二维超声心动图和99mTc-MIBI心肌灌注显像检测两组患者左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）及心肌灌注情况。结果术后3、6个月二维超声心动图检查显示两组患者LVEF、LVEDD均较术前改善,组间比较观察组较对照组改善程度更大（P均〈0.05）。术后6个月99mTc-MIBI心肌灌注显像显示两组患者充盈缺损区域均较术前缩小,观察组较对照组充盈缺损区域缩小程度更明显（P均〈0.05）。结论 CABG联合自体外周血干细胞移植治疗心肌梗死安全可行,患者术后心肌灌注和心功能恢复满意。     

冠状动脉造影正常的心肌梗塞患者核素心肌灌注显像

目的 :分析冠状动脉造影正常的心肌梗塞患者核素心肌灌注显像表现。　　方法 :回顾总结了 18例冠状动脉造影正常的心肌梗塞患者 99m锝 -甲氧基异丁基异腈 (99m Tc- MIBI)静息心肌断层显像。　　结果 :18例心肌梗塞患者心肌灌注显像均显示异常 ,12例有节段性缺损 ,6例未见缺损但可见心肌节段性稀疏。心肌灌注显像对心肌梗塞的定位与心电图 Q波比较 ,显示病变部位更明确。　　结论 :心肌灌注显像提供了冠状动脉造影正常的心肌梗塞患者心肌损伤部位及程度。     

Simultaneous analysis of myocardial perfusion and ventricular function. Normal values in the Mexican population

Myocardial perfusion imaging is an useful procedure in the evaluation of patients with coronary artery disease, Gated SPECT technique evaluates simultaneously perfusion and ventricular function, left ventricular ejection fraction (LVEF), ventricular volumes and the transient ischemic dilatation of the left ventricle. OBJECTIVE: To evaluate the normal ventricle volumes and the ejection fraction of the LV obtained automatically with the Gated SPECT in Mexican population. METHODS: 100 patients were studied with low likelihood for CAD. All of them were studied with Tc-99m Sestamibi Gated SPECT. We obtained automatically the LVEF, and the end diastolic and systolic left ventricular volumes. RESULTS: Myocardial perfusion, regional motion and systolic thickening were normal in all patients. We obtained the mean values of EF and end diastolic and systolic volumes. These values were lower in female. CONCLUSION: Tc-99m Sestamibi myocardial perfusion SPECT is an useful procedure, with high accuracy for the simultaneous evaluation of myocardial perfusion and ventricular function.     

腺苷负荷心肌灌注显像141例临床分析

目的:腺苷负荷心肌灌注显像(MPI)与冠状动脉造影(CAG)2种检查方法的结果对比分析。方法:对141例患者分别行腺苷负荷MPI及CAG检查,并使用校正的TIMI血流分级(CTFC)方法评价冠状动脉血流速度。对2种方法的检查结果进行比较分析。结果:腺苷负荷MPI阳性的99例患者中,经CAG检查确诊冠心病者52例,冠状动脉慢血流(CSF)者37例,冠状动脉正常者10例。腺苷负荷MPI对冠心病诊断的灵敏度和特异度为92.9%和44.7%;对CSF诊断的灵敏度和特异度为82.2%和75.0%。结论:腺苷负荷MPI阳性者中一部分为冠心病患者,一部分为CSF者,对于腺苷负荷MPI异常的患者需进一步行CAG检查以明确病情。     

Relations of the myocardial imaging agents 99mTc-MIBI and 201T1 to myocardial blood flow in a canine model of myocardial ischemic insult

Myocardial imaging with thallium 201 has proven to be an important clinical procedure to assess the severity of the myocardial ischemic insult. Uptake of 201Tl is related to perfusion to and extraction by intact myocardium. Recently, a newer group of agents based on 99mTc alkyl isonitriles has been developed and appears promising for myocardial imaging. Although the distribution of this new agent has been shown to be related to myocardial perfusion, its dependence on myocardial integrity has not been established. This study compared the distribution of 99mTc-2-methoxy-isobutyl-isonitrile (99mTc-MIBI) with that of 201Tl in a clinically relevant canine model of ischemic insult. Fifteen adult dogs underwent 2 hours of occlusion by left anterior descending coronary artery ligation followed by reperfusion. In one group of dogs, 201Tl and 99mTc-MIBI were administered 5 minutes before 35 minutes of reflow (group 1, n = 5). In the other animals, the agents were given 5 minutes after onset of reflow, and dogs were killed after 10 (group 2, n = 5) and 35 minutes of reperfusion (group 3, n = 5). 99mTc-MIBI activity was significantly correlated with 201Tl activity (r = 0.91, 0.77, and 0.92, for groups 1, 2, and 3, respectively). Both 201Tl and 99mTc-MIBI activities were correlated similarly with blood flow in all models. In groups 1 and 2, 201Tl and 99mTc-MIBI activities correlated directly with microsphere-determined blood flow, whereas in group 3, they correlated inversely. The present study shows that in these models of myocardial ischemic insult, 99mTc-MIBI distribution is closely related to that of 201Tl.     

Planar myocardial scintigraphy with 99mTc sestamibi for the evaluation of the infarct area and the efficacy of the thrombolytic therapy]

BACKGROUND: Nuclear cardiology permits the estimation of myocardial infarction size and the result of the thrombolytic therapy. The aim of the study was to demonstrate the feasibility of the planar myocardial scintigraphy with tecnetium-99m-sestamibi in the coronary intensive care unit for the early identification of the infarct size and the results of the thrombolytic therapy. MATERIAL AND METHODS: We studied 15 patients affected by a first acute myocardial infarction (AMI), 10 anterior and 5 inferior wall, treated with thrombolysis (APSAC 30U i.v.) within and interval of 3 hours from the symptoms onset, tecnetium-99m-sestamibi was injected before thrombolysis and after 3 +/- 1 hours the planar imaging was registered with a mobile gamma-camera. Scintigraphic evaluation was repeated after 24 hours and before patient discharge. Within 48 hours from the thrombolytic therapy the coronary angiography was performed for the demonstration of patency of the infarct-related artery. The left ventricle myocardial perfusion was divided in the 3 planar projections into 13 segments. The perfusion in each segment was evaluated with a perfusion score: 0 = normal, 1 = moderately reduced, 2 = severely reduced, 3 = absent. The sum of the hypoperfused segments represented the infarct size. A perfusion score improvement greater than 40% was considered a marker of reperfusion. RESULTS: The infarct size involved 4.2 +/- 1.5 segments in the anterior and 2 +/- 0.8 segments in the inferior wall infarctions (p < 0.05). The scintigraphic imaging made 24 hours after AMI allowed the diagnosis of coronary reperfusion in 10 patients. The coronarography demonstrated the infarct related artery patency in 14 patients. The nuclear imaging at patient discharge provided the diagnosis or reperfusion in 11 cases and demonstrated an improvement of the myocardial perfusion score in 8 cases. CONCLUSIONS: In patients with AMI treated with thrombolysis the scintigraphic imaging with tecnetium-99m-sestamibi is feasible with a mobile gamma-camera in the intensive coronary care unit. The quality of planar imaging is good and allows the evaluation of myocardial infarct size and the efficiency of thrombolytic therapy. An earlier scintigraphic imaging should be taken into consideration for a more timely non-invasive evaluation of patients who need coronary angiography and, if necessary, a rescue-PTCA.