动态心电图诊断病毒性心肌炎应用价值

目的:探讨动态心电图诊断病毒性心肌炎的价值及意义。方法:对136例拟诊病毒性心肌炎患者的动态心电图和常规心电图资料进行对比分析,并同时进行肌钙蛋白及心肌酶谱检测。结果:动态心电图结果异常112例,常规心电图异常64例,二者比较差异有统计学意义(P<0.01)。结论:动态心电图可提高病毒性心肌炎患者心律失常及心肌缺血的检出率,可对心律失常作定性分析,排除器质性病变,为病毒性心肌炎的诊断提供可靠依据。     

小儿病毒性心肌炎动态心电图分析

目的探讨小儿病毒性心肌炎动态心电图特点。方法分析86例小儿病毒性心肌炎常规心电图及动态心电图结果。结果小儿病毒性心肌炎动态心电图异常,主要有心律失常为室性早搏、房性早搏以及房室传导阻滞,常合并ST-T改变。动态心电图阳性率96.5%,高于常规心电图的阳性率74.4%。结论动态心电图对小儿病毒性心肌炎具有重要的诊断价值。     

动态心电图在儿童病毒性心肌炎中的应用价值

目的 探讨动态心电图对儿童病毒性心肌炎的诊断及随访价值。方法 对36例儿童病毒性心肌炎或疑似病毒性心肌炎分别于就诊三天内和治疗十天后进行常规12导联心电图及心电图24小时监测 ,所得结果进行对比分析。结果 就诊三天内动态心电图监测各种心律失常及ST-T异常阳性率为88.89 % ,与常规心电图阳性率55.78 %有极显著差异 (χ2=15.38 ,p<0.005) ;治疗十天后动态心电图监测阳性率为61.11% ,也极显著高于常规心电图的27.78 % (χ2=8.10,p<0.005)。结论 动态心电图监测对病毒性心肌炎的诊断更确切 ,并可作为治疗过程中随访手段。     

动态心电图监测在小儿病毒性心肌炎诊断中的应用价值

我科1993年1月至1998年6月临床疑诊为病毒性心肌炎患儿116例,全部行常规心电图(ＥＣＧ)检查,57例作了24小时动态心电图(ＤＣＧ)检查。现将资料分析如下。1　临床资料1.1　一般资料　116例中,男71例,女45例,年龄4～12(平均8)岁。其中4～6岁12例,～8岁28例,～10岁32例,～12岁44例。1.2　方法　全部病例行ＥＣＧ检查。其中57例同时行ＤＣＧ检查。1.3　诊断标准　所有心电图描记中,凡符合全国9省市协作组制定的小儿病毒性心肌炎诊断标准中所列出的心电图异常者,均判为阳性病例。2　结果　　在对病毒性心肌炎患儿心电图检查中,ＥＣＧ和ＤＣＧ所发…     

急性病毒性心肌炎252例动态心电图分析

急性病毒性心肌炎是一种常见的心血管疾病,可出现各种心律失常,本文对动态心电图监测结果分析如下。 1 资料与方法 1.1 临床资料 本文收集1990年1月～1995年8月住院治疗的252例急性病毒性心肌炎患者,均符合急性病毒性心肌炎的诊断标准。男112例,女140例;年龄14～30岁218例,31～50岁30例,≥51岁4例,平均年龄34.4±10.7岁。病程小于6个月。 1.2 方法 采用国产DZS-2 Holter(高性能携带式Holter系统),选用CM_1、CM_5双极胸导联进行24小时动态心电图(AECG)观测,所有患者都在住院后1～7天内监测,Holter检查前仅做对症支持治疗,未用任何抗心律失常药物。结果经回放仪高速回放分析并打印,然后人工分析核实,排除各种伪差及干扰。     

42例病毒性心肌炎动态心电图监测分析

１临床资料按９省市心肌炎诊断标准,诊断为病毒性心肌炎２２例为Ａ组,其中男１２例,女１０例,年龄４～１４岁,因心悸、胸闷就诊２０例为Ｂ组,其中男１１例,女９例,年龄４～１４岁,Ｂ组经临床心脏彩超、Ｘ光胸片、心肌酶等检查确诊为无器质性心脏病。ＥＣＧ诊断标准及参考值根据北京儿童医院编《实用儿童心电图学》。室性早搏按Ｌｏｗｎ分级。ＤＣＧ仪采用ＦＤ－２型,受检者连续佩带２４ｈ。２结果Ａ组ＥＣＧ室早１２例次,其中ＬｏｗｎⅠ级、Ⅱ级分别为２,１０例次,房早８例次,窦性心动过速２０例次,Ⅱ度窦房传导阻滞８例次,…     

病毒性心肌炎动态心电图与临床表现相关性分析

选取2013年1月~2014年1月我院收治的60例具有临床症状的病毒性心肌炎患者的病例资料,根据患者的临床症状分为3组,23例发热患者为A组,31例心悸、胸痛、胸闷患者为B组,29例水肿患者为C组。分析60例患者的动态心电图资料,将患者动态心电图资料与其临床症状进行对比,并分析。结果 60例病毒性心肌炎患者中窦性心动过速32例(53.33%),窦性心动过缓5例(8.3%),ST-T改变42例(70%),窦性心律不齐18例(30%),传导阻滞35例(58.33%),期前收缩37例(61.66%),房室肥大13例(21.67%),肢体导联低电压11例(18.33%);A组患者中82.61%出现窦性心动过速,高于其他两组,差异具有统计学意义,B组患者中有80.65%出现ST-T改变,90.32%出现期前收缩,高于其他两组,差异具有统计学意义,C组患者中89.66%出现肢体导联低电压,与其他两组相比,差异具有统计学意义。病毒性心肌炎患者动态心电图与临床表现具有相关性,动态心电图可较好的反应患者的心肌受损情况,有助于临床诊断。     

动态心电图与常规心电图在急性病毒性心肌炎早期诊断中应用价值比较

目的:评估动态心电图与常规心电图在急性病毒性心肌炎早期诊断中应用价值。方法:本课题选取我院2017年9月-2019年10月时段内诊疗的急性病毒性心肌炎患者,共60例。均对患者施行常规心电图、动态心电图检查,通过和病理结果间的比较,比较各诊断方式阳性率。结果:常规心电图诊断方式阳性率为83.33%,动态心电图诊断方式阳性率为95.00%,数据间比较有意义(P<0.05)。结论:针对急性病毒性心肌炎患者,动态心电图和常规心电图均可起到早期诊断效果,但前者阳性率较高,应加大推广力度。     

SPECT门控心肌灌注断层显像对小儿病毒性心肌炎的诊断价值探讨

目的：观察SPECT门控心肌灌注断层显像对小儿病毒性心肌炎诊断的应用价值。方法：静注^99mTc-MIBI1.5小时后行SPECT门控心肌灌注断层显像并阅片诊断。结果：病例组21例为阳性，阳性率达到87．5％。结论：SPECT门控心肌灌注断层显像对小儿病毒性心肌炎诊断有重要的价值，值得进一步扩大临床应用。     

201Tl心肌灌注显像对病毒性心肌炎的诊断价值

目的探讨心肌灌注显像结合靶心图定量分析技术,对病毒性心肌炎的诊断价值。方法对106例临床诊断病毒性心肌炎患者及30例正常对照者,进行运动负荷和静息铊-201心肌灌注断层显像,常规图像重建后,对短轴心肌进行靶心图定量分析。结果 106例病毒性心肌炎患者铊-201心肌灌注显像,靶心图异常有78例,呈＂花斑状＂特征,阳性率为73.6%。病毒性心肌炎患者心肌缺血范围分数（ES）为（3.94±5.95）,缺血严重分数（SS）是（124.06±64.03）,与正常对照组的差异均有显著意义（P〈0.01）。结论铊-201心肌灌注显像结合靶心图定量分析,是评价心肌炎心肌受累范围和程度的有效手段。     

201Tl心肌显像诊断病毒性心肌炎

目的 探讨²⁰¹Tl心肌灌注显像对病毒性心肌炎的诊断价值。 方法 对168例临床确诊的心肌炎患者进行²⁰¹Tl心肌灌注显像。 结果 阳性组(Ⅰ~Ⅲ度)142例;阴性组(0度)26例。阳性组中放射性稀疏Ⅰ度60例(42.25%);Ⅱ度57例(40.14%);Ⅲ度25例(17.61%)。左心室前壁受累者在阳性组中占90.14%(128/142);下后壁受累占82.39%(117/142);侧壁受累占31.69%(45/142);间壁受累占27.46%(39/142);9例静息显像左心室射血分数减低较负荷后EF减低更为明显。结论 ²⁰¹Tl心肌灌注显像能直观地表现病变心肌的部位、形态、范围及程度,运动或药物负荷试验,能安全、无创地增加心肌炎的检出率,是诊断心肌炎的一种敏感手段。     

Non-invasive diagnosis of in stent stenosis by stress 99m technetium tetrofosmin myocardial perfusion imaging

Background The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS).Methods We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9±0.5 years after percutaneous coronary interventions in which stents were deployed. Coronary angiography was performed within 3 months of the stress test. ISS was defined as ≥50% stenosis in a coronary segment with previous stenting. Significant coronary artery disease (CAD) was defined as ≥50% stenosis within or outside the stented coronary segment.Results The stent was deployed in 1 coronary artery in 52 patients, and in 2 coronary arteries in 20 patients (a total of 92 detected in 42 (58%) patients (51 stents). Reversible perfusion abnormalities were present in 34 of patients with ISS (sensitivity=81%, CI 70–94). Regional sensitivity for diagnosis of stenosis per stent was 76% (CI 65–88), specificity was 83% (CI 71–94) and accuracy was 79% (CI 69–85). Reversible perfusion abnormalities were detected in ≥2 vascular distributions in 15 of 22 patients with multi-vessel CAD and in 5 of 50 patients without (sensitivity for identifying multivessel CAD=68%, CI 50–89; specificity=90%, CI 82–98; and accuracy=83%, CI 75–90).Conclusion Stress 99m technetium tetrofosmin myocardial perfusion imaging is a useful non-invasive technique for the diagnosis of in stent stenosis and extent of CAD in patients with previous percutanenous coronary artery interventions.     

^99Tc^m-MIBI心肌显像对儿童病毒性心肌炎的临床意义

目的 评价~(99)Tc~(m)-甲氧基异丁基异晴(MIBI)心肌显像对儿童病毒性心肌炎诊断和病情观察的价值。方法 对38例住院患儿(15例确诊、23例疑似病毒性心肌炎)行~(99)Tc~m-MIBI心肌断层显像,并对照7例正常儿重。全部对象均行临床常规检查。将左心室心肌划分为9个节段,进行放射性分布半定量分析(0分=分布正常,1分=2个断面以上稀疏,2分=明显稀疏,3分=缺损)。结果 38例患儿心肌显像阳性23例,阳性率为61％,评分3分、2分、1分的例数分别为1例(占4%)、13例(占57％)、9例(占39％),6例为多节段稀疏。7例正常儿重心肌显像阳性1例,假阳性率为14％。~(99)Tc~m-MIBI心肌显像与临床表现及常规检查较一致;稀疏较轻者,往往疗效较好。结论 ~(99)Tc~m-MIBI心肌显像有助于儿重病毒性心肌炎的诊断,而且提供了病情监测、预后判断的有效手段。     

核素心肌灌注的定量及异质性分析对病毒性心肌炎的诊断价值

目的 探讨核素心肌灌注的定量及异质性分析诊断病毒性心肌炎（VMC）的价值。方法 回顾性分析接受^99mTc-MIBI心肌灌注显像的疑似VMC患者37例,其中18例临床诊断为VMC（VMC组）,其余19例排除VMC的患者为非VMC组。使用QPS软件获得静息灌注总积分（SRS）及总灌注缺损值（TPD）,计算靶心图放射性计数异质性参数节段靶心图变异系数（CV_s）和室壁靶心图变异系数（CV_w）,比较2组心肌灌注各参数的差异。应用ROC曲线评价各参数对VMC的诊断效能。结果 VMC组心肌灌注以左心室前壁和下壁降低最显著（P均<0.05）;VMC组TPD、CV_s较非VMC组均明显增高（P均<0.05）;CV_s对VMC炎诊断效能最优（AUC=0.83,P<0.01）,当CV_s阈值为10.5%时,其灵敏度为94.4%,特异度为73.7%。结论 心肌灌注异质性分析有助于VMC的诊断和鉴别诊断。     

Stress-only Tc-99m myocardial perfusion imaging in an emergency department chest pain unit

Background

Stress-only myocardial perfusion imaging (MPI) saves time by eliminating rest imaging, which is important for emergency department (ED) throughput but has not been studied in an ED population.

Study Objective

To determine the prognosis of a normal stress-only MPI study compared to a normal rest-stress MPI and establish its effectiveness in an ED setting.

Methods

All patients evaluated in the ED over 6.5 years who underwent a stress-only technetium-99m gated MPI were compared to those who had a rest-stress study. All-cause mortality was determined using the Social Security Death Index. Survival was analyzed in patients with normal and abnormal MPI results.

Results

A total of 4145 studies (2340 stress-only, 1805 rest-stress) were performed. Patients’ average age was 57.9 years, 38.5% were male, and most had an intermediate or low pretest risk of coronary artery disease (87.7%). Average follow-up was 35.9 ± 20.9 months. In patients with normal perfusion, at 1 year of follow-up there were 11 deaths in the stress-only group (0.5% 1-year mortality), and 13 deaths in the rest-stress cohort (1.1% 1-year mortality). At the end of follow-up, the stress-only group had a lower all-cause mortality (p < 0.0001) and similar risk adjusted all-cause mortality (p = 0.10) than the rest-stress cohort. Patients with abnormal perfusion demonstrated the expected differential prognosis based on total perfusion deficits in both groups.

Conclusions

A normal stress-only MPI study has a benign 1-year prognosis similar to a rest-stress study when performed in the ED. The ability to triage patients more rapidly and reduce radiation exposure represents an attractive alternative for low-risk patients.     

Tc-99m tetrofosmin myocardial SPECT perfusion imaging: comparison of rest-stress and stress-rest protocols

Aim. The purpose of this study was to evaluate the diagnostic value of Tc-99m tetrofosmin SPECT myocardial perfusion scintigraphy rest/stress and stress/rest protocols for the assessment of coronary artery disease (CAD). Methods. 65 patients underwent both rest and stress SPECT imaging in a one-day protocol and coronary angiography within 2 months before or after scintigraphy. Scintigraphic data was obtained according to two different protocols; 1) rest-stress (n=18) and 2) stress-rest (n=47). Results. Scintigraphic evidence for myocardial ischaemia was found in 36 patients (55%). The overall sensitivity to detect CAD (>50% luminal stenosis) was 94% (34/36), specificity 66% (19/24), positive predictive value 77%, negative predictive value 90%. The sensitivity to detect CAD for protocols 1 and 2 were 100% and 93%, specificity 56% and 70%, positive predictive value 69% and 81% and negative predictive value 100% and 88%, respectively. The left anterior descending coronary artery showed a sensitivity (overall, protocol 1 & 2) of 78%, 75% (3/4) and 79% (15/19) and a specificity of 71%, 64% (9/14) and 75% (21/28). The right coronary artery showed a sensitivity (overall, protocol 1 & 2) of 91%, 100% (6/6) and 88% (14/16) and a specificity of 70%, 92% (11/12) and 61% (19/31). The left circumflex coronary artery showed a sensitivity (overall, protocol 1 & 2) of 50%, 67% (2/3) and 46% (6/13) and a specificity of 94%, 100% (15/15) and 91% (31/34). Conclusion. Tc-99m tetrofosmin appears to be a valuable tool in predicting significant CAD. The sensitivity and the positive predictive value are high, making this test highly appropriate for the diagnosis of CAD. The diagnostic value of the individual coronary arteries is high to moderate. No significant differences were found between both protocols.     

Non-invasive imaging in the diagnosis of acute viral myocarditis

Autopsy series of consecutive cases have demonstrated an incidence of myocarditis at approximately 1–10%; on the contrary, myocarditis is seriously underdiagnosed clinically. In a traditional view, the gold standard has been myocardial biopsy. However, it is generally specific but invasive and less sensitive, mostly because of the focal nature of the disease. Thus, non-invasive approaches to detect myocarditis are necessary. The traditional diagnostic tools are electrocardiography, laboratory values, especially troponin T or I, creatine kinase and echocardiography. For a long period, nuclear technique with indium-111 antimyosin antibody has been used as a diagnostic approach. In the last years, the use of this technique has declined because of radiation exposure and 48-h delay in obtaining imaging after injection to prevent blood pool effect. Thus, a non-invasive diagnostic approach without radiation and online image availability has been awaited. Cardiac magnetic resonance imaging has these promising characteristics. With this technique, it is possible to analyse inflammation, oedema and necrosis in addition to functional parameters such as left ventricular function, regional wall motion and dimensions. Thus, cardiovascular magnetic resonance imaging has emerged as the most important imaging tool in the diagnostic procedure and the review focus on this field. But there are also advances in echocardiography and computer tomography, which are described in detail.     

Clinical experience with technetium-99m teboroxime scintigraphy in patients referred for myocardial perfusion evaluation

A series of 30 patients (25 males, 5 females, age=28–73 years) with a clinical indication of thallium-201 stress/4 hours redistribution scintigraphy has been studied using stress/rest (n=7) or rest/stress (n=23) protocols with technetium-99 m teboroxime (CARDIOTEC, Squibb Diagnostics) in order to assess the clinical usefulness of this new molecule and to compare it to thallium. In all cases coronary artery disease was known or highly suspected, with a history of myocardial infarction in 18 cases (subacute n=6, remote n=12) and/or previous by-pass surgery or PTC A in 5 cases. Medical treatment was not discontinued at the time of stress testing. Coronary angiography was available for 27 patients. Exercise tests for both tracers were carried out on an ergometric bicycle during the same day and the levels of exercise achieved for the thallium studies were very similar to those achieved for teboroxime. Imaging was performed in three planar projections and sudies were evaluated using a model with 4 territories: septal and anterior assumed to correspond to the LAD artery, lateral and latero-posterior (=LCX), inferior and posterior (=RCA) and apex. Classification of results was: normal, ischemic, infarcted and infarcted with ischemia. With reference to the thallium-201 results, agreement was found in 86% (37/43) of normal regions and in 82% (63/77) of abnormal regions. Relative to documented coronary artery lesions (27 patients) sensitivity and specificity of thallium and teboroxime for exact correspondence between arteries and territories were, respectively: thallium, se=71%, sp=64%, teboroxime, se=67%, sp=75%. These results indicate the ability of Cardiotec to evaluate myocardial perfusion with an important time saving since the complete study durations (stress and rest) were: thallium=4h 34 min ?22 min and teboroxime=1 h 57 min ?41 min.