~(99)Tc~m-NOET门控心肌灌注SPECT评价冠心病的价值

目的 评价~(99)Tc~m-双(N-乙氧基,N-乙基-二硫代氨基甲酸酯)氮化锝(~(99)Tc~m-NOET)静息门控断层心肌灌注显像对冠心病患者的诊断价值.方法 疑诊为冠心病的45例患者注射925 MBq~(99)Tc~m-NOET后1h用SPECT行静息门控心肌灌注显像,获得舒张未期容积(EDV)、收缩未期容积(ESV)、左室射血分数(LVEF)等心功能参数和舒张末期容积灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图.所有患者在1周内行冠状动脉造影,将冠状动脉狭窄≥50%定为病变血管.根据冠状动脉造影结果将其分为心肌梗死组、心肌缺血组和对照组三组.结果 ~(99)Tc~m-NOET静息门控SPECT诊断冠心病的灵敏度和特异度分别为68.42%和83.33%.心肌梗死组的心功能参数[EDV=(129.32±9.14)ml,ESV=(80.97±9.49)ml,LVEF=(40.15±3.28)%]与对照组[EDV=(80.91±3.12)ml,ESV=(30.12±1.79)ml,LVEF=(63.51±1.04)%]相比,统计学差异有显著性(EDV:F=22.103,ESV:F=32.277,LVEF:F=42.604,均为P＜0.01),心肌缺血组的心功能参数[(EDV=(70.83±3.46)ml,ESV=(25.13±2.85)ml,LVEF=(65.55±2.62)%]与对照组相比,统计学差异无显著性意义.心肌梗死组左室心肌共分为460个节段,其中209个节段局部灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图均异常.局部灌注异常的节段共328个节段.伴有局部射血分数、局部室壁活动和室壁增厚度异常分别有250个、240个和276个节段.局部灌注异常的节段与局部射血分数、局部室壁活动和室壁增厚度异常的节段不完全匹配.结论 ~(99)Tc~m-NOET静息门控心肌灌注显像对冠心病的诊断有较大临床应用价值,所获得的整体心室功能参数在心肌梗死的评价中有优越性,但对心肌缺血的诊断价值不大.心肌梗死中存在有不少的局部灌注与心肌室壁功能异常节段的不匹配,对心肌存活的评价有帮助.     

定量门控99Tcm-tetrofosmin心肌显像测量左室功能

目的探讨定量门控(QG)99Tcm-tetrofosmin心肌显像测量左室功能的临床应用价值.方法74例受试者进行了门控99Tcm-tetrofosmin心肌显像,采用QGSPECT专用分析程序全自动测量左室功能.其中36例同时进行静息门控心室显像,以比较两种方法测量左室功能的相关性.结果①74例99Tcm-tetrofosminQGSPECT全自动定量测定左室功能均获成功.②QGSPECT全自动测量36例受试者的静息左室射血分数(LVEF)、舒张末期容积(EDV)、收缩末期容积(ESV)分别与静息门控心室显像计算结果显著正相关(r分别为0.859,0.914,0.950,P均<0.001),重复性好.③心肌缺血组(n=28)静息LVEF与对照组(n=23)比较差异无显著性,而心肌梗死组(n=9)静息LVEF明显低于对照组(t=6.33,P<0.001).结论定量门控心肌显像99Tcm-tetrofosmin能准确评价左室功能.     

定量门控~(99)Tc~m-tetrofosmin心肌显像测量左室功能

目的　探讨定量门控 (QG) 99Tcm tetrofosmin心肌显像测量左室功能的临床应用价值。方法　 74例受试者进行了门控99Tcm tetrofosmin心肌显像 ,采用QGSPECT专用分析程序全自动测量左室功能。其中 36例同时进行静息门控心室显像 ,以比较两种方法测量左室功能的相关性。结果　①74例99Tcm tetrofosminQGSPECT全自动定量测定左室功能均获成功。②QGSPECT全自动测量 36例受试者的静息左室射血分数 (LVEF)、舒张末期容积 (EDV)、收缩末期容积 (ESV)分别与静息门控心室显像计算结果显著正相关 (r分别为 0 .85 9,0 .914,0 .95 0 ,P均 <0 .0 0 1) ,重复性好。③心肌缺血组 (n =2 8)静息LVEF与对照组 (n =2 3)比较差异无显著性 ,而心肌梗死组 (n =9)静息LVEF明显低于对照组 (t=6 .33,P <0 .0 0 1)。结论　定量门控心肌显像99Tcm tetrofosmin能准确评价左室功能     

静息门控心肌显像评价冠心病患者CABG术后早期疗效

目的应用^99Tc^m-甲氧基异丁基异腈（MIBI）心肌灌注及心室显像评价冠状动脉旁路移植（CABG）术的近期疗效。方法对52例接受CABG术的患者于手术前1周、术后3～5周分别行静息心肌灌注及心室显像，采用QGSPECT专用软件程序定量分析整体及局部心室功能，并与超声心动图检查结果进行比较。结果①术后^99Tc^m-MIBI显像示左室射血分数（LVEF）提高（P〈0．05），左室舒张末期容积（EDV）、收缩末期容积（ESV）均明显减小（P〈0．001），与超声心动图检查示EDV、ESV变化结果符合。②手术前后LVEF改变值与整体室壁运动（WM）改变值（r=0．75，P〈0．01）及整体室壁收缩增厚率（WT）改变值（r=0．51，P〈0．01）均有良好相关性；手术前后整体-12,肌血流灌注值与整体WM值（r=0．54、0．36，P均〈0．01）及整体WT值（r=0．63、0．65，P均〈0．01）均有较好的相关性。③术后心肌显像剂相对摄取值提示前壁、间隔、下壁多节段心肌灌注明显改善（P〈0．05）。④术后显像提示前壁、间隔的WM降低（P〈0．05），下壁、前侧壁、下侧壁WM明显改善（P〈0．05），并与超声心动图结果基本符合；WT仅下侧壁明显改善（P〈0．05），在间隔无变化（P〉0．05）。结论CABG术后心肌显像的WM低估间隔室壁运动，高估侧壁运动；WT与心肌血流灌注在手术前后均有较好的相关性，可能更适用于评价CABG术后心功能。     

心脏彩超评价西宁地区急性心肌梗塞自体骨髓干细胞移植效果

目的：采用超声评价经冠状动脉自体骨髓干细胞移植治疗后高海拔地区急性心肌梗塞左室收缩功能及心肌局部运动改变。方法：2004年3月-2007年6月期间入院的33例急性前壁心肌梗死患者随机分为两组,细胞移植组患者在术前、术后6月、术后12月行超声检查,测量左室射血分数（LVEF）、左室舒张末期容积（EDV）、左室收缩容积（ESV）、每搏量（SV）。结果：移植术后6月患者左室射血分数由术前（40．93±7．38）％升至（48．57±5．17）％,（P〈0．05）。结论：自体骨髓干细胞移植可明显改善左心室收缩功能和心肌局部运动．     

一日法99Tcm-替曲膦运动-静息门控心肌灌注显像的临床研究

目的 探讨使用亚锡替曲膦药盒能否得到满足临床需要的99Tcm-替曲膦(TF)以及1d内完成99Tcm-TF运动-静息G-MPI的可行性.方法 回顾性分析52例行99Tcm-TF运动-静息G-MPI且均有CAG结果的受试者资料.标记亚锡替曲膦并进行放化纯检测.1d内对受试者分别在运动负荷及静息状态下静脉注射99Tcm-TF 370和740 MBq,30 min时行G-MPI.2次注射显像剂间隔时间为(129±4)min.运动负荷状态下注射99Tcm-TF后加行1～ 30 min前位胸腹部平面动态显像和2h前位平面显像.用ROI技术分析胸腹部平面动态像,得到左室心肌、肝及胸部放射性变化情况;用Cedars心肌定量分析软件分析左室心肌各节段灌注情况及左室功能参数(LVEF、EDV、ESV等).1周内行超声心动图检查,获取LVEF、EDV和ESV.对运动-静息G-MPI(取2次显像平均值)心功能参数与超声心动图结果采用SPSS 17.0进行配对t检验.结果 99Tcm-TF放化纯为(97.5±0.4)％.G-MPI左室心肌显影清晰;动态显像示左室心肌与肝放射性比值12 min后逐渐增大,30 min时达0.710,2h延迟显像左室心肌内放射性基本清除.以CAG为“金标准”,G-MPI诊断心肌缺血的灵敏度为84.6％ (22/26),特异性为92.3％(24/26);G-MPI与超声心动图测定的LVEF、EDV和ESV分别为(60.27±7.49)％和(60.84±5.98)％,(97.82±18.98)ml与(98.70-±17.89) ml,(47.67 ±10.32) ml与(45.49 ±10.15) ml,差异均无统计学意义(t=1.254、0.835和0.981,P均＞0.05).结论 采用亚锡替曲膦药盒标记得到的99Tcm-TF能够满足临床需要;99Tcm-TF能够在1d内完成运动负荷及静息G-MPI,可作为常规评价心肌灌注及左室功能的显像剂.     

^99Tc^m—MIBI静息门控心肌灌注显像在心肌梗死干细胞移植治疗中的价值

目的用^99Tc^m-甲氧基异丁基异腈（MIBI）静息门控心肌灌注显像的方法,评价急性心肌梗死（AMI）患者自体骨髓间质干细胞（MSC）移植术治疗的疗效。方法AMI患者31例,均行经皮冠状动脉介入治疗（PCI）术,其中18例患者作为试验组,于PCI术后行自体MSC移植术治疗,PCI术后拒绝行细胞移植治疗的13例患者作为对照组。于PCI术前,术后1,3和6个月进行^99Tc^m-MIBI静息门控心肌灌注断层显像,评价心肌血流灌注及心功能改善程度。统计学处理采用SPSS11．0软件,行t检验。结果所有患者术后1个月放射性稀疏节段数明显减少,术后3个月和6个月放射性缺损节段数试验组（2．37±1．09和2．21±0．93）较对照组（3．24±0．93和3．21±1．05）明显减少（t=2．32,2．79,P均〈0．05）;与术前[（35．4±16．7）％和（32．8±15．9）％]相比,术后6个月试验组[（57．2±14．3）％]和对照组[（44．8±11．7）％]患者左心室射血分数（LVEF）均显著升高（t=4．27,2．18,P均〈0．05）,试验组患者LVEF明显高于对照组（t=2．58,P〈0．05）。结论心肌梗死患者自体MSC移植术后,应用^99Tc^m-MIBI静息门控心肌灌注显像随访和评价疗效有一定临床价值。     

核素显像识别存活心肌的临床应用进展

存活心肌的判断对冠心病患者治疗方案的选择及预后十分重要。201Tl再注射法、硝酸甘油介入的静息99Tcm-sestamibi法增强了心肌灌注核素体层显像对存活心肌的检测能力,门控SPECT技术能在评估心肌灌注的同时计算LVEF(左心室射血分数)、局部室壁运动和局部室壁增厚率,具有符合线路的SPECT可以进行心肌代谢显像及灌注显像,其对存活心肌的检测能力可能接近于PET,而检查费用可大大降低。     

核素显像识别存活心肌的临床应用进展

存活心肌的判断对冠心病患者治疗方案的选择及预后十分重要。^201Tl再注射法、硝酸甘油介入的静息^99Tc^m-sestamibi法增强了心肌灌注核素体层显像对存活心肌的检测能力，门控SPECT技术能在评估心肌灌注的同时计算LVEF(左心室射血分数)、局部室壁运动和局部室壁增厚率，具有符合线路的SPECT可以进行心肌代谢显像及灌注显像，其对存活心肌的检测能力可能接近于PET，而检查费用可大大降低。     

门控心肌SPECT显像三种定量分析软件测定左心室容积和射血分数的比较

目的研究定量门控心肌断层显像（QGS）、爱莫瑞心脏工具箱（ECToolbox）和四维模型心肌断层显像（4D-MSPECT）3种定量分析软件所测左心室射血分数（LVEF）、舒张末期容积（EDV）和收缩末期容积（ESV）的相关性以及与左心室造影之间的相关性。方法临床疑诊或确诊冠心病患者212例均行99^Tc^m-MIBI门控心肌SPECT显像，并分别以QGS、ECToolbox和4D-MSPECT软件处理得LVEF1、EDV1、ESV1。其中106例患者行左心室造影，分别测得LVEF2、EDV2、ESV2。比较3种软件之间及其与左心室造影之间的相关性。结果3种软件所测LVEF1、EDV1、ESV1的相关性好，所测LVEF1值的r值为0．89～0．91（P均〈0．001），EDV1、ESV1值的r值为0．97～0．98（P均〈0．001）。对于LVEF1和EDV1，QGS、ECToolbox、4D-MSPECT所测值间的差异具有统计学意义（P〈0．001）。QGS所测值[LVEF1：（59．2±11．4）％、EDV1：（88．8±35．5）ml]低于4D-MSPECT所测值[LVEF1：（64．2±12．6）％、EDV1：（98．1±39．5）ml]，4D—MSPECT所测值又低于ECToolbox所测值[LVEF1：（68．3±12．8）％、EDV1：（108．2±39．0）ml]；而对于ESV1，QGS[（39．0±27．0）ml]、ECToolbox[（37．9±31．4）ml]与4D—MSPECT[（38．7±31．3）ml]所测值之间差异无统计学意义（P=0．92）。门控心肌SPECT显像与左心室造影所测LVEF2、EDV2、ESV2的相关性好，r值分别为0．70～0．80，0．57～0．61和0．87—0．89（P均〈0．001）。结论3种门控SPECT定量分析软件所测值之间及与左心室造影的相关性均较好。     

Left ventricular ejection fraction and volumes on rest gated 201Tl perfusion SPECT: comparison with two-dimensional echocardiography

BACKGROUND: Rest gated 201Tl images are considered to be of poor count statistics due to lower energy and low photon flux of 201Tl in addition to increased attenuation and low dose that can be administered. We compared the left ventricular ejection fraction (LVEF), end diastolic (EDV) and end systolic volume (ESV) obtained on 4 h gated rest 201Tl myocardial perfusion single photon emission computed tomography (SPECT) with those obtained by two-dimensional echocardiography (2-D ECHO) in patients with known or suspected coronary artery disease (CAD). METHODS: Eighty-two consecutive patients who underwent gated 201Tl stress-rest myocardial perfusion SPECT and 2-D ECHO were studied. The gated thallium images were processed with Siemens e-soft autocardiac processor and LVEF, EDV and ESV were evaluated using Emory Cardiac Toolbox. The same parameters were also assessed on the 2-D ECHO using the modified Simpson method for comparison. RESULTS: Out of 82 rest gated images, one study was excluded because of poor count statistics. In 81 (99%) patients there was good linear correlation with 2-D ECHO values and rest gated 201Tl SPECT images for EDV, ESV and LVEF. Pearson's correlation co-efficient (r value) for EDV, ESV and LVEF between the two methods was 0.78, 0.79 and 0.88, respectively. A Bland-Altman plot showed close agreement with LVEF but not for EDV and ESV. CONCLUSION: These results suggest that the 4 h rest gated 201Tl study gives a reliable value for the LVEF compared to 2-D ECHO and can be used in routine clinical practice.     

Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning

Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of 99mTc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (<5%) of coronary artery disease (CAD). In 50 of the 147 (34%) of patients with reversible perfusion defects, post-stress LVEF was >5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P=0.008 and P<0.000001, respectively) and with the subgroup 2A (P=0.011 and P<10(-12), respectively). The ESV stress/rest ratio correlated significantly with the summed WT difference score by univariate analysis in stunned patients. It can be concluded that the post-stress ESV dilation, obtained by stress/rest gated SPECT, seems to be due to endocardial post-ischemic stunning. The stunned patients showed more severe clinical, angiographic, perfusion and function parameters.     

Prognostic value of ECG-gated thallium-201 single-photon emission tomography in patients with coronary artery disease

BACKGROUND: The phenomenon of reversible impairment in LV function has been well described and is known as myocardial stunning. OBJECTIVE: Thallium-201 myocardial perfusion gated SPECT was used to evaluate myocardial stunning and its incremental prognostic value in patients with coronary artery disease. PATIENTS AND METHODS: Fifty-six patients (aged 63+/-11 years) with coronary artery disease were included in this study. All subjects underwent exercise thallium scintigraphy. ECG-gated SPECT was obtained both at post-stress (10 minutes after the injection of 111 MBq of thallium at the time of peak exercise) and at rest (180 minutes). The left ventricular ejection fraction (LVEF) and end-systolic and end-diastolic volume (ESV, EDV) were determined by a quantitative gated SPECT (QGS) program. RESULTS: Follow-up was complete in all patients (mean 569 days). The magnitude of the depression of post-stress LVEF relative to the rest LVEF was correlated with the severity of ischemia (p < 0.05). The group with a median LVEF of more than 45% had a significantly higher event-free rate (p < 0.01). CONCLUSION: Assessment of post-stress left ventricular function by gated-SPECT provides incremental prognostic information and is useful in predicting cardiac events in patients with suspected or definite coronary artery disease.     

Assessment of left ventricular function by gated myocardial perfusion and gated blood-pool SPECT: Can we use the same reference database?

The purpose of this study was to compare left ventricular (LV) volume and ejection fraction (LVEF) measurements obtained with electrocardiographic gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (GS-MPI) with those obtained with gated SPECT cardiac blood-pool imaging (GS-pool). Fifteen patients underwent GS-MPI with technetium-99m-tetrofosmin and GS-pool with technetium-99m-erythrocyte, within a mean interval of 8 +/- 3 days. Eight patients had suspected dilated cardiomyopathy and seven patients had angiographically significant coronary artery disease. End-diastolic volume (EDV), end-systolic volume (ESV) and LVEF measurements were estimated from GS-MPI images by means of Cedars-Sinai automatic quantitative program and from GS-pool images by the threshold technique. Mean differences between GS-MPI and GS-pool in EDV, ESV and LVEF measurements were -2.8 +/- 10.5 ml [95% confidence interval (CI): -8.6 +/- 3.0 ml], 2.6 +/- 7.3 ml (CI: -1.4 +/- 6.6 ml) and -2.3 +/- 5.1% (CI: -5.1 +/- 0.6%), respectively. No significant difference in the mean differences from 0 was found for EDV, ESV or LVEF measurements. Bland-Altman plots revealed no trend over the measured LV volumes and LVEF. For all parameters, regression lines approximated lines of identity. The excellent agreement between GS-MPI and GS-pool measurements suggests that, for estimation of LV volumes and LVEF, these two techniques may be used interchangeably and measurements by one method can serve as a reference for the other.     

201Tl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测定左心室射血分数的对比研究

目的 探讨201Tl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量左心室射血分数(LVEF)的相关性.方法 72例受检者接受201Tl静息门控心肌灌注体层显像,用AUTOQUANT 4.21软件测量LVEF,并与24 h内的静息99mTc-红细胞平衡法门控心血池显像结果进行比较.结果 ①门控心肌灌注体层显像与门控心血池显像测量LVEF值的结果呈明显正相关(r=0.554,P=-0.000),两种方法无统计学差别(t=1.194,P＞0.05).②不同疾病组之间两种测量方法无统计学差异(P值均大于0.05).③门控心肌灌注体层显像及门控心血池显像测量的LVEF值分别为(64.68±10.77)%和(62.46±8.99)%,门控心肌灌注体层显像测量的LVEF值要比门控心血池显像高出3.55%.结论 201Tl门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量LVEF值的相关性好且结果准确,但门控心肌灌注体层显像的LVEF测量值要稍高于门控心血池显像.     

Quantifying transient ischemic dilation using gated SPECT.

Transient ischemic dilation (TID) is both a sensitive and a specific indicator of triple-vessel coronary artery disease. This finding, obtained from ungated SPECT images, is the ratio of the average ventricular size after stress compared with rest. With gated SPECT, however, measurements of the end-diastolic volume (EDV) and end-systolic volume (ESV) can be obtained, and the relative contributions of each to the TID ratio may be estimated. The objective of this study was to quantify the relative contributions of the EDV and ESV when correlating an optimized stress-induced volume ratio (SIVR) with myocardial ischemia. METHODS: A retrospective review was made of 422 consecutive patients undergoing gated SPECT myocardial perfusion imaging. Semiquantitative summed stress and rest scores were determined using a 17-segment, 5-point model. The presence of myocardial ischemia was defined as a summed difference score of >or=3 (i.e., myocardial ischemia of >4%). Poststress-to-rest ratios of the EDV, ESV, and left ventricular ejection fraction (LVEF) were correlated with myocardial ischemia. Using a brute force method, relative weights were assigned empirically to the EDV and ESV to calculate an optimized SIVR having the strongest correlation with myocardial ischemia. RESULTS: There was a significant correlation between the presence or absence of ischemia and the ESV ratio (P<0.01), the EDV ratio (P<0.01), and the LVEF ratio (P<0.05). When controlling for age, type of stress, and sex, the strongest correlation was with the ESV ratio. The SIVR most strongly correlated with myocardial ischemia was found to be the stress-to-rest ratio of the (ESVx5.0+EDV). This SIVR was more strongly correlated with myocardial ischemia than the stress-to-rest ESV ratio, EDV ratio, or LVEF ratio. CONCLUSION: Compared with either the ESV or the EDV stress-to-rest ratio alone, the combination of both results in a stronger correlation with myocardial ischemia. The contribution of the ESV was found to be 5 times greater than the contribution of the EDV when determining a SIVR most strongly correlated with stress-induced myocardial perfusion defects.     

99Tcm-MIBI门控心肌灌注断层显像与超声心动测定左室射血分数的对比研究

目的探讨GE VG/Hawkeye单光子发射断层扫描仪(SPECT)随机携带3种左室射血分数算法对静息态99Tcm-MIBI门控心肌断层显像测定左室射血分数(LVEF)的临床应用价值。方法对103例、6组受检者进行门控心肌断层显像,使用3种算法分别测定3组左室射血分数(LVEF0、LVEF1、LVEF2),分别与M型超声心动获得的LVEF(UEF)进行对比分析。结果(1)103例受检者图像显影清晰;(2)根据不同算法获得门控心肌断层显像3组LVEF值(EF0、EF1、EF2)与超声心动图检查结果(UEF)均具有显著相关性(r0=0.948、r1=0.937、r2=0.940),其中EF0与UEF一致性较好;(3)静息态99Tcm-MIBI门控心肌断层显像测定左室射血分数可重复性好(P<0.05);(4)各组间t检验示:心肌缺血组、心梗组及扩张型心肌病组与正常组比较均存在显著性差异(P<0.05);高血压组、心肌炎组、扩张型心肌病和心肌缺血组比较均存在显著性差异(P<0.05);高血压组、心肌炎组、扩张型心肌病组与心梗组比较均存在显著性差异(P<0.05);扩张性心肌病组与心肌炎组比较亦存在显著性差异(P<0.05)。结论静息态99Tcm-MIBI静息态门控心肌断层显像测定左心室射血分数(LVEF)可靠,3种算法中以第一种最好,具有较好的临床应用价值。     

Exercise-induced stunning continues for at least one hour: evaluation with quantitative gated single-photon emission tomography

To elucidate the after-effect of exercise on left ventricular (LV) function, end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) were evaluated at 1 h after exercise and at rest by technetium-99m tetrofosmin gated myocardial single-photon emission tomography (SPET) using an automated program in 53 subjects. The subjects were grouped as follows: normal scan (n = 16), ischaemia (n = 19) and infarction (n = 18), based on the interpretation of perfusion images. Postexercise LVEF did not differ from resting LVEF in the groups with normal scan and infarction. In patients with ischaemia, postexercise EDV (90+/-17 ml, mean +/-SD) and ESV (44+/-15 ml) were significantly higher than EDV (84+/-15 ml, P = 0.001) and ESV (36+/-14 ml, P<0.0005) at rest. LVEF was significantly depressed 1 h after exercise (53%+/-9% vs 58%+/-9%, P<0.0001). In ischaemic patients with depressed postexercise LVEF, LVEF difference between rest and postexercise showed a significant correlation with the sum of defect scores, which were reversible from exercise to rest perfusion images (r = 0.92, P<0.0001). These results indicate that exercise-induced LV dysfunction (myocardial stunning) continues for at least 1 h in ischaemic patients and that the extent of LVEF depression is determined by the severity of ischaemia.