运动试验心肌显像异常及其类型对冠心病患者预后判断的价值

目的评价运动试验心肌显像异常及其类型对判断冠心病患者预后的价值。方法对６９例冠心病患者进行运动负荷心肌显像及运动ＥＣＧ试验，心肌显像均有异常。４５例经冠状动脉造影证实为冠心病，随访时间６～１１０个月，未发生心脏事件者随访皆≥１２个月。结果随访中１５例发生心脏事件，发生率为８７％／年。经多因素Ｃｏｘ回归分析表明，心肌显像可逆缺损节段数与发生心脏事件有密切关系。１３例显像不可逆缺损范围不大者，与以往报道的正常组结果比较，未发生心脏事件率差异无显著性（χ２＝００９，Ｐ＞００５）。表明心肌显像正常或呈不可逆缺损范围不大者预后良好。结论可逆缺损节段数是预测冠心病患者日后发生心脏事件的较好指标。     

Global quantification of left ventricular myocardial perfusion at dynamic CT imaging: Prognostic value

Background

There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI).

潘生丁试验在冠心病心肌显像中的意义

目的：对９９ｍ Ｔｃ － Ｍ Ｉ Ｂ Ｉ心肌显像中潘生丁试验的分析,旨在评价该法在冠心病（ Ｃ Ａ Ｄ） 诊断中的意义。方法：２１ 例正常人和８８ 例 Ｃ Ａ Ｄ 患者在９９ｍ Ｔｃ － Ｍ Ｉ Ｂ Ｉ心肌显像时进行潘生丁试验。结果：潘生丁试验诊断冠心病的灵敏度为８３ ％ ,特异性为９０ ．５ ％ ,与极量运动试验相仿。结论：本法简便易行,适应证宽,值得临床推广。     

Prognostic stratification of obese patients by stress 99mTc-tetrofosmin myocardial perfusion imaging.

Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients. METHODS: We studied 265 patients with a body mass index greater than 30 kg/m2 by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomography. Endpoints during follow-up were cardiac death and death of any cause. RESULTS: The mean patient age (+/-SD) was 59 +/- 10 y, and 110 of the patients were men (42%). The mean body mass index was 37 +/- 7 kg/m2. Scan findings were normal in 113 patients (43%). Myocardial perfusion abnormalities were fixed in 62 patients (23%) and reversible in 90 patients (34%). During a mean follow-up period of 5.5 +/- 2 y, 41 patients (15%) died. Death was considered cardiac in 22 patients (8%). Nonfatal myocardial infarction occurred in 20 patients (7.5%). The annual cardiac death rate was 0.6% in patients with normal perfusion and 3.3% in patients with abnormal perfusion. Patients with a multiple-vessel distribution of abnormalities had a higher cardiac death rate than did patients with a single-vessel distribution (4.1% vs. 2.5%, P < 0.05). The annual mortality rate was 1.3% in patients with normal perfusion and 4.2% in patients with abnormal perfusion. In a multivariate analysis, perfusion abnormalities were independently predictive of cardiac mortality (risk ratio, 3.2; 95% confidence interval, 1.5-6.7) and overall mortality (risk ratio, 2.7; 95% confidence interval, 1.4-4.3). CONCLUSION: Stress 99mTc-tetrofosmin myocardial perfusion imaging is a useful tool for predicting cardiac and overall mortality in obese patients.     

Prognostic implications of stress Tc-99m tetrofosmin myocardial perfusion imaging in patients with left ventricular hypertrophy

Background  Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiac death. Data on the prognostic value of myocardial perfusion imaging (MPI) in patients with LVH are limited. The aim of this study is to assess the independent value of stress technetium 99m tetrofosmin MPI in predicting the long-term mortality rate in patients with LVH. Methods and Results  We studied 177 patients (mean age, 59±12 years; 134 men) with LVH by electrocardiographic criteria who underwent dobutamine or exercise stress Tc-99m tetrofosmin MPI. Endpoints during follow-up were cardiac and all-cause death and hard cardiac events. A normal scan was detected in 42 patients (24%). Myocardial perfusion abnormalities were fixed in 59 patients (33%) and reversible in 76 (43%). Perfusion abnormalities were observed in a single-vessel distribution in 79 patients and in a multivessel distribution in 56. During a mean follow-up period of 5.5±2 years, 60 patients (34%) died. Death was considered cardiac in 42 patients (24%). Nonfatal myocardial infarction occurred in 10 patients (6%). The annual mortality rate was 1.4% in patients with normal perfusion, 3.2% in those with perfusion abnormalities in a single-vessel distribution, and 8% in those with a multivessel distribution. In a multivariate analysis independent predictors of death were age (risk ratio [RR], 1.05; 95% confidence interval [CI], 1.02–1.07), male gender (RR, 1.9; 95% CI, 1.1–3.6), hypercholesterolemia (RR, 1.7; 95% CI, 1.0–2.9), and abnormal perfusion (RR, 2.7; 95% CI, 1.5–4.8). Conclusion  In patients referred for stress MPI, LVH is associated with a high mortality rale, with approximately one third of patients dying over a period of 5 years. Stress Tc-99m tetrofosmin MPI provides independent information for predicting death in these patients. This study was supported in part by a limited publication grant from GE Healtheare.     

Comparison of stress-only vs. stress/rest with technetium-99m methoxyisobutylisonitrile myocardial perfusion imaging

Unlike conventional thallium-201 myocardial imaging, technetium-99m methoxyisobutylisonitrile (MIBI) requires separate stress and rest injections. We prospectively studied 148 consecutive patients referred for myocardial perfusion studies to determine the diagnostic value of rest images once normal exercise or dipyridamole tomographic images had been obtained. In patients referred with no history of previous myocardial infarction in whom the diagnosis of coronary artery disease was suspected, 45 of 109 (41%) patients had normal stress tomographic images. Obtaining rest images did not alter the final interpretation in any of these cases. From this we infer that in patients with normal images after exercise or dipyridamole administration and no past history of myocardial infarction, ^99mTc-MIBI rest images are not required. This provides several advantages including increased speed of diagnosis, decreased patient radiation exposure, improved cost efficiency and decreased demand on tomographic camera time. Offprint requests to: A.Y. Fung     

运动负荷后早期门控心肌显像对冠心病严重三支病变的诊断价值

目的比较运动负荷早期(15～20min)^99Tc^m-甲氧基异丁基异腈(MIBI)门控心肌显像(G-MPI)和非门控心肌显像(NG-MPI)诊断冠心病(CAD)严重三支病变(狭窄≥70％)的价值。方法以冠状动脉(简称冠脉)造影(CAG)所示冠脉直径狭窄≥70％为严重CAD诊断标准，将同期做运动负荷^99Tc^m-MIBI SPECT G-MPI和CAG的215例患者分为CAD三支病变组(A组)与CAD非三支病变组(B组)。结果G-MPI与NG-MPI诊断严重CAD的灵敏度分别为95．3％(143／150例)和90．7％(136／150例，X^2=2．509，P=0．113)，特异性分别为80．0％(52／65例)和72．3％(47／65例，X^2=1．059，P=0．303)；诊断CAD三支病变的灵敏度分别为100％(51／51例)和92．2％(47／51例)，前者更好，且两者差异有显著性(X^2=4．163，P=0．041)。结论在诊断临床高危CAD严重三支病变时，G-MPI比NGMPI更有价值。     

糖尿病冠状动脉粥样硬化性心脏病的发病机制及核素心肌灌注显像的研究进展

糖尿病发病率不断升高,心血管系统病变是其主要并发症,冠状动脉疾病是导致糖尿病患者死亡的主要原因。负荷核素心肌灌注显像可早期诊断糖尿病患者中罹患心脏病者,判断预后及进行危险度分层,为早期防治糖尿病冠状动脉粥样硬化性心脏病提供依据,从而提高糖尿病患者生活质量、降低糖尿病冠状动脉粥样硬化性心脏病死亡率。     

双核素门控心肌断层显像对心肌缺血的诊断价值

目的　提高心肌断层显像技术对冠心病诊断的准确性和实用性。方法　采用双核素门控心肌断层显像对 10 3例受检者进行检查 ,患者分为冠心病组 (3 7例 )和非冠心病组 (66例 )。静息注射2 0 1Tl和运动高峰注入99Tcm 甲氧基异丁基异腈 (MIBI) ,40min后一次性进行门控双能峰断层采集。分析比较运动和静息的断层图像 ,以及室壁运动、心肌灌注、室壁增厚度和区域射血分数值等 4个功能图像和左室功能参数 :左室射血分数、舒张末期容积和收缩末期容积 (LVEF、EDV和ESV) ,并以不同角度的“双网图”分析各心壁运动情况。有 3 8例在 2周内进行冠状动脉造影。结果　冠心病组检查阳性 94.6% (3 5 / 3 7例 ) ,阴性 5 .4% (2 / 3 7例 ) ;非冠心病组中检查阳性 10 .6% (7/ 66例 ) ,阴性89.4% (5 9/ 66例 )。冠心病组中双核素门控心肌断层显像提示心肌缺血共 48个节段 ,其中有 3 2个在功能图像上出现室壁运动下降和 (或 )区域LVEF值降低 (66.7% )。冠心病组LVEF(% ) ,EDV(mL)和ESV(mL)分别为 5 2 .3 3± 16.2 6,70 .45± 2 8.12和 3 3 .3 5± 18.86,非冠心病组分别为 61.76± 9.3 8,60 .45± 18.18和 2 3 .3 0± 11.0 9,两组之间比较P <0 .0 1(t=2 .96) ,P <0 .0 5 (t =2 .5 5 ) ,P <0 .0 5 (t =2 .67)。其中 3 8例与冠状     

定量门控201Tl心肌显像对冠心病患者的预后价值

目的 研究定量门控201Tl心肌显像对冠心病患者预后评估及冠心病治疗方案选择的价值.方法 对84例患者进行静息和运动负荷201Tl门控心肌灌注SPECT显像,并随访(32.92±16.77)个月.对心肌灌注图像进行评分(1～4分),计算总负荷评分(SSS)、总静息评分(SRS)和总差值分(SDS=SRS-SSS)、负荷左室射血分数(EF)值和静息EF值.结果 随访中9例发生心脏事件,年发生率为3.90%.SSS、SDS、SRS以及EF值均是心脏事件的独立预测因素(P＜0.005).Cox比例风险回归分析示SSS是心脏事件的最强预测因素.根据患者的负荷后EF值、SDS等可将患者分为低危、中危和高危组.结论 应用定量门控201Tl心肌显像可以对冠心病患者进行正确的预后评估,并可指导选择治疗方案.SSS是心脏事件的最强预测因素.     

^99mTc-MIBI心肌灌注断层显像假阴性与假阳性的临床分析

目的探讨^99mTc-MIBI（甲氧基异睛）心肌灌注断层显像与冠状动脉造影不一致的临床意义。方法136例临床诊断为冠心病患者,于冠状动脉造影术（CAG）前2周内行^99mTc-MIBI心肌灌注断层显像（运动或药物负荷及静息显像）。以CAG为金标准,分析^99mTc-MIBI心肌灌注断层显像假阳性与假阴性的临床意义。结果两者不相符合13例,^99mTc-MIBI心肌灌注断层显像阳性而冠状动脉正常者10例,^99mTc-MIBI心肌灌注断层显像阴性而冠状动脉造影阳性者3例。结论^99mTc-MIBI心肌灌注断层显像阴性而冠状动脉造影阳性提示冠脉临界病变,^99mTc-MIBI心肌灌注断层显像阳性而冠状动脉造影阴性提示冠脉微循环灌注不足。     

核素心肌断层显像诊断瓣膜病人合并冠状动脉病变的价值

为了解瓣膜病患者是否合并冠状动脉病变，对６３例经临床确诊为瓣膜疾病的病人在外科手术前行＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像，其中５５例做运动或药物负荷试验，８例单纯行静息心肌显像；２７例行冠状动脉造影；５７例行瓣膜外科手术。所有病人手术前、后均作超声心动图检查。结果：２７例心肌ＳＰＥＣＴ显像与冠状动脉造影结果对比，符合率为９６．３％（２６／２７）；与冠状动脉造影、外科手术后临床及     

心肌灌注显像联合冠状动脉钙化积分诊断冠心病的价值及最新进展

心肌灌注显像（MPI）在冠心病的诊断、危险度分层及预后评价中扮演着越来越重要的角色,冠状动脉钙化积分（CACS）可协助对冠心病患者进行进一步的危险度分层,但两者有各自的局限性和不足。将两者联合应用可以相互弥补不足,为临床提供更多的信息。行SPECT/CT心肌灌注显像时,需进行衰减矫正CT（CTAC）扫描,若采用心电门控的呼气末屏气螺旋CT扫描,则在用于MPI衰减矫正的同时又可用于CACS测定,实现一站式检查,在减少患者辐射剂量的同时又可为临床提供更多的信息。笔者综述了CACS、MPI及两者联合应用的临床价值,并对一站式采集MPI与CACS的最新进展进行了综述。     

用运动负荷99Tcm-MIBI SPECT心肌显像预测急性心肌梗死预后

目的：探讨运动负荷99Tcm-甲氧基异丁基异腈（MIBI）SPECT心肌断层显像判断急性心肌梗死（AMI）患者预后的价值。方法：对101例AMI患者出院前行运动负荷99Tcm-MIBI SPECT检查，随访心脏良性与不良事件的发生，分析心脏事件发生的相关因素及评估对心脏事件的预测价值。结果：多因素相关分析表明，AMI后心脏不良事件的独立预测因素是既往有心肌梗死病史，低运动积分和左室射血分数（LVEF）＜40％，。结论：AMI患者出院前行99Tcm-MIBI SPECT检查或获取运动能力，左室功能和心肌缺血状况等资料，从而鉴别高危患者，评估不良预后，有助于对高危患者及早进行介入治疗。     

Accuracy of stress Tc-99m tetrofosmin myocardial perfusion tomography for the diagnosis and localization of coronary artery disease in women

Background  Earlier studies have suggested a modest accuracy of stress thallium 201 myocardial perfusion imaging (MPI) for the diagnosis of coronary artery disease (CAD) in women. The accuracy of stress MPI with technetium 99m tetrofosmin has not been studied in women. The aim of this study was to assess the accuracy of stress Tc-99m tetrofosmin MPI for the diagnosis and localization of CAD in women. Methods and Results  We studied 88 women who underwent exercise or dobutamine stress Tc-99m tetrofosmin tomography and coronary angiography within 3 months. Significant CAD was defined as a stenosis 50% or greater in diameter in at least 1 major epicardial coronary artery. Myocardial perfusion abnormalities were detected in 44 of 53 patients with significant CAD and in 7 of 35 patients without significant CAD (overall sensitivity, 83% [95% confidence interval (CI), 73%-93%]; specificity, 80% [95% CI, 67%-93%]; and accuracy, 82% [95% CI, 74%-90%]). The sensitivity was 72% (18/25) in patients with single-vessel CAD and 93% (26/28) in patients with multivessel CAD. Perfusion abnormalities were detected in 2 or more vascular distributions in 20 of 28 patients with multivessel CAD and in 4 of 60 patients without multivessel CAD (sensitivity for the identification of multivessel CAD, 71% [95% CI, 55%-88%]; specificity, 93% [95% CI, 86%-98%]; and accuracy, 86% [95% CI, 79%-93%]). The sensitivity, specificity, and accuracy were 82%, 84%, and 83%, respectively, for the diagnosis of CAD in the left anterior descending artery; 77%, 84%, and 81%, respectively, for CAD in the right coronary artery; and 74%, 80%, and 78%, respectively, for CAD in the left circumflex artery. Conclusion  Stress Tc-99m tetrofosmin MPI is an accurate noninvasive technique for the diagnosis and localization of CAD in women. Supported in part by a publication grant from GE Healthcare     

Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging

BACKGROUND: Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach. METHODS AND RESULTS: We reviewed 200 consecutive patients without known CAD who were referred for CAC scoring shortly after nonischemic MPI. Of these, 13 (6.5%) had CAC scores greater than 400, indicating significant CAD; 22 (11%) had CAC scores of 101 to 400; 27 had CAC scores of 11 to 100; and the remainder (n = 138) has CAC scores of 1 to 10. Traditional risk factors and patient characteristics were not significant predictors of CAC scores of 101 or greater. However, age and the Framingham risk score were predictors of CAC scores greater than 0. At follow-up, significantly more patients with CAC scores of 101 or greater had been given the advice to take lipid-lowering medication and aspirin compared with those with CAC scores of 0. CONCLUSIONS: Of patients referred for CAC scoring after nonischemic MPI, 17.5% were identified as having CAD based on a CAC score greater than 100, allowing intervention with aggressive medical therapy. Patients who were reclassified were not easily identifiable by traditional risk factors, but Framingham risk score did predict the presence of CAC. Clinicians modified medical therapy based on the results of CAC scoring.     

Prognostic predictors and outcomes in patients with abnormal myocardial perfusion imaging and angiographically insignificant coronary artery disease

Background. Abnormal stress myocardial perfusion imaging studies (SMPI) with angiographically insignificant coronary artery disease (ICAD) have often been labeled “false positive” scans. We evaluated the prognostic predictors and outcomes in an unselected patient population having abnormal SMPI and ICAD (study group) over a 24 month period of follow-up. Methods. Retrospective study of consecutive patients who had SMPI and subsequent coronary angiography showing ICAD within 6 months of index scan with matched control group with normal scans. Major Adverse Cardiac Events (MACE) were defined as the first occurrence of death or myocardial infarction (MI). Patients were followed up to 24 months from the time of their SMPI to identify the development of MACE. Results. One hundred and twenty five patients formed the study group and one hundred and thirty six patients formed the control group. Over a two-year follow up, approximately 13% of the study group had MACE as compared to 4.2% in the control group (P=022). Abnormal SMPI, EF<40% and chronic kidney disease (GFR<60 ml/min) were independent predictors of MACE in the study group. In multivariate analysis for MACE prediction, chronic kidney disease remained the sole independent predictor regardless of size or severity of perfusion abnormalities (P<.001). Conclusion. Patients with abnormal SMPI and ICAD have a 13% event rate of MACE over a two-year follow up. CKD seems a very important marker of a higher risk subgroup amongst such patients.     

静息/负荷82Rb PET门控心肌灌注显像定量分析的价值

目的 探讨门控和定量分析技术在82Rb PET心肌灌注显像中的应用价值.方法 对32例临床可疑冠心病患者进行静息/腺苷负荷82Rb PET门控心肌灌注显像.原始数据按常规处理成断层图像,再应用定量分析软件Emory Cardiac Toolbox(ECTb)进行定量分析.由3位有经验的核医学科医师分别对图像质量(优、良、一般、差、无法分析)、左心室射血分数(LVEF)的可信程度(同意、基本同意、不确定、基本不同意、不同意)、左心室功能的其他指标对诊断的价值(很有帮助、有帮助、不确定、基本无帮助、无帮助)进行评价.将观察指标分为肯定组和否定组,分别计算其百分率和90%可信区间.结果 192组分析结果中,图像质量优良者共计160组,占83.3%(160/192),其95%可信区间为78.1%～88.6%;图像质量为一般和差的共计32组,占16.7%(32/192),其95%可信区间为11.4%～21.9%.对LVEF的结果表示同意和基本同意者共计164组,占85.4%(164/192),其95%可信区间为80.4%～90.4%;认为不确定和基本不同意或不同意者共计28组,占14.6%(28/192),其95%可信区间为9.6%～19.6%.应用定量分析软件获得的除LVEF以外左心室功能的其他指标,认为很有帮助和有帮助者共计102组,占53.1%(102/192),其95%可信区间为46.1%～60.2%;不确定和基本无帮助或无帮助者90组,占46.9%(90/192),其95%可信区间为39.8%～53.9%.结论 门控和定量分析技术有助于PET图像阅片者作出更正确的诊断.     

Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease

The role of non-invasive imaging techniques in the evaluation of patients with suspected or known coronary artery disease (CAD) has increased exponentially over the past decade. The traditionally available imaging modalities, including nuclear imaging, stress echocardiography and magnetic resonance imaging (MRI), have relied on detection of CAD by visualisation of its functional consequences (i.e. ischaemia). However, extensive research is being invested in the development of non-invasive anatomical imaging using computed tomography or MRI to allow detection of (significant) atherosclerosis, eventually at a preclinical stage. In addition to establishing the presence of or excluding CAD, identification of patients at high risk for cardiac events is of paramount importance to determine post-test management, and the majority of non-invasive imaging tests can also be used for this purpose. The aim of this review is to provide an overview of the available non-invasive imaging modalities and their merits for the diagnostic and prognostic work-up in patients with suspected or known CAD.     

Clinical evaluation of the 99mTc-CPI myocardial perfusion imaging

^99mTc-CPI myocardial perfusion scintigraphy including planar images in 35 patients and SPECT images in 16 patients has been studied. Scintigraphic data revealed that high quality ^99mTc-CPI myocardial perfusion images were obtained. The sensitivity and specificity of ^99mTc-CPI planar images in detecting CAD was 92% and 80% respectively. There was no significant difference in sensitivity for detecting CAD between planar and SPECT. However, the specificity of SPECT was much better than that of planar imaging.