核素心肌灌注显像在冠心病危险度分层中的临床意义

目的 评价核素心肌灌注显像在冠心病危险度分层中的临床价值及意义.方法 对均进行了核素心肌灌注显像[核素选用99mTc-甲氧基异腈(MIBI),心肌灌注显像采用静息-腺苷药物负荷试验]及冠状动脉(简称冠脉)造影的13例患者进行观察和对比,对核素心肌灌注显像阳性者10例、核素心肌灌注显像阴性者3例与各自的冠脉造影对比,评判核素心肌灌注显像对胸闷、胸痛等不同症状患者心肌缺血程度初步估测,并进行危险评估.结果 核素心肌灌注显像提示严重心肌缺血6例,在相应冠脉造影中均发现冠脉病变多为2支以上,且狭窄程度多在70%以上,均进一步行球囊扩张和(或)支架置入术;提示轻度心肌缺血4例,随后冠脉造影发现多为1支病变,狭窄程度多为50%～70%,均进行药物治疗;另3例核素心肌灌注显像阴性者冠脉造影无明显异常发现.结论 核素心肌灌注显像对冠心病进行危险度分层及选择治疗、评估预后有重要意义.     

核素心肌显像在判断冠心病亚组预后和危险度分层中的应用

过去的30年中,一些非介入性的心脏检查手段在临床上得到了广泛应用。从70年代早期开始,核素心肌显像的临床应用每年以15％的速度上升。现在核素心肌显像可以精确评估运动和静息状态下的局部心肌灌注和心室功能,并能对各种冠心病(CAD)患者进行准确的危险度分层及预后评估,从而为这些患者选择合适的治疗方案提供可靠依据。 循证医学是评估和应用新技术的准则。迄今,核素心肌显像在CAD危险度分层及预后评估方面已经积累了非常多的资料,比其他任一非介入性影像检查都要多,这些资料清楚地证明,核素心肌显像比临床资料以及冠状动脉造影能更好地对CAD患者进行危险度分层和预后评估。依据大量的资料现可对亚组的慢性CAD患者进行准确的危险度分层和预后评估。在大量的可疑CAD患者中,本文     

核素心肌灌注显像与冠状动脉造影在冠心病疑诊患者危险度评估中的相关性研究

目的 研究核素心肌灌注显像(MPI)与冠状动脉造影(CAG)对冠心病疑诊(S-CAD)患者危险度分层的相关性.方法 选取该院2019年3月至2020年12月入院的90例S-CAD患者,所有患者均接受M PI和CAG检查.根据M PI所示患者心肌节段放射性摄取减低程度及CAG所示患者冠状动脉狭窄程度分别对患者进行危险度分...     

核素心肌灌注断层显像在冠心病诊断的价值

目的：评估心肌灌注断层显像在冠心病诊断的价值。方法：采用定性、半定量方法回顾性分析１２５例冠心病患者左心室心肌血流灌注情况,并与ＥＣＧ结果作比较。结果：心肌灌注断层显像对心肌缺血的检出率为７８％,心梗１００％,均明显高于ＥＣＧ。结论：心肌灌注显像安全、无创伤,对冠心病缺血及梗死心肌的检出有实用价值。     

冠心病患者核素心肌灌注断层显像对PTCA术疗效评价

目的应用^99mTc-甲氧异晴（MIBI）心肌灌注断层显像判断经皮冠状动脉腔内成形术（PTCA）及支架置入术的疗效。方法54例冠心病患者在PTCA/支架术前、术后分别行运动＋静息或静息＋硝酸甘油介入心肌灌注断层显像检查。结果PTCA/支架置入术后,患者的缺血心肌节段及不可逆灌注缺损节段减少,即术前分别为2.64±0.43及3.64±0.47,术后分别为1.54±0.29及2.34±0.40。结论成功的PTCA/支架置入术治疗能明显改善冠心病心肌缺血。核素心肌灌注断层显像对PTCA术的疗效评价准确可靠,为一种有价值的无创性方法。     

冠心病核素心肌显像的临床意义

冠心病核素心肌显像的临床意义Ｔｈｅｃｌｉｎｉｃａｌｓｉｇｎｉｆｉｃａｎｃｅｏｆ~（９９ｍ）Ｔｃ－ＭＩＢＩｉｎｍｙｏｃａｒｄｉａｌｔｏｍｏｇｒａｐｈｌｙｏｆｃｏｒｏｎａｒｙｈｅａｒｔｄｉｓｅａｓｅ￥／／王敏中，张顺超，兰智（第三军医大学西南医院心血管内?..     

冠心病患者心肌灌注显像的影像表现

目的对104倒冠心病患者进行心肌灌注显像,分析其影像特点。方法对104例患者进行潘生丁介入^99n Tc—MIBI（740MBq）SPECT心肌灌注显像,由3位医生分别进行读片（双盲法）,分析其影像表现,以6壁段（前壁、侧壁、间壁、下壁、心尖和基底部）方式分别判断是否有左心室心肌肥厚、灌注降低等征象。有2位以上判断相同者为有效,并记录备用。结果104例冠心病患者心肌灌注显像的影像表现为灌注降低和节段性心肌肥厚,二者可能单独存在,也可并存;104例患者中81例呈现灌注降低,30例呈现节段性心肌肥厚,其检出率分别为77.8％和28．8％;具有多壁段、多病灶的特点,灌注降低以前壁、下壁（各占32．7％）最常见,节段性心肌肥厚以侧壁（35．6％）最常见。结论冠心病患者心肌灌注显像不仅袁现为灌注降低,而且可伴发节段性心肌肥厚,具有多壁段、多病灶的特点。     

心肌灌注显像对冠心病经皮冠脉介入治疗的疗效评估

<正>冠心病(CAD)是常见的心血管系统疾病,当冠脉病变导致管腔狭窄超过其直径的50%时,即可出现CAD临床表现。近年来经皮冠脉介入治疗(PCI)已被广泛应用于临床。但因其不能反映心脏介入治疗后的心肌灌注血流信息,且有创、不宜多次操作,故寻找一种安全、有效的无创性检查作为PCI治疗后疗效评价的手段成为当今医学界不断探索的新方向。     

核素心肌显像对冠心病的诊治

不少到心血管病医院就诊的患者,当得知心肌灌注显像正常时,兴奋地说:"多少年来一直诊断我为冠心病,吃了许多药,输了大量液,花了好多钱,结果经查不是冠心病,我太高兴了,终于摘了冠心病的帽子。"     

99Tcm氮欧乙替心肌核素显像的冠心病诊断分析

目的评价再分布型显像剂99 Tcm氮欧乙替(N-NOET)心肌核素显像(MPI)对于冠心病诊断的敏感性和特异性.方法住院病人同时行冠状动脉造影和99TcmN-NOET腺苷负荷试验MPI.腺苷总量为840μg/kg,6 min匀速静脉泵入,腺苷泵入3 min时静脉推注99TcmN-NOET剂量740MBq(20 mCi),15 min后行负荷心肌显像,2 h后进行再分布心肌显像.结果入选53例,年龄35～79(56±10)岁,男36例,女17例.冠状动脉有一支血管直径狭窄超过50%即冠状动脉明显狭窄组31例,MPI均为阳性;冠状动脉无明显狭窄组22例,MPI阳性6例,MPI阴性16例.99TcmN-NOET腺苷负荷试验MPI对于冠状动脉狭窄超过50%的敏感性为100%,特异性为73%,阳性预测值为84%,阴性预测值为100%.9例冠心病病人接受了再血管化处理,有6例病人的桥支血管或冠状动脉支架内有再狭窄,其中5例病人对应区域出现灌注不良;3例病人无明显冠状动脉支架内再狭窄,MPI均阴性.结论再分布型显像剂99TcmN-NOET MPI对于冠状动脉狭窄诊断的敏感性和特异性较高,且检查能在同一天内进行,有较好的临床应用价值.     

藏族冠心病患者腺苷负荷心肌核素显像心脏和颈动脉彩超检测结果比较

目的了解腺苷负荷核素心肌显像（MPI）、颈动脉彩超（CAU）及超声心动图（UCG）对藏族冠心病患者的诊断价值。方法冠脉造影确诊为冠心病的藏族患者32例,回顾性分析了颈动脉彩超、超声心动图、腺苷负荷核素心肌显像资料：结果核素心肌显像阳性检出率为75．0％（24／32）,心脏彩超阳性检出率为59．3％（19／32）,颈动脉彩超斑块阳性率为68．8％（22／32）。核素显像与心脏彩超结果完全一致的为25例（78．1％）。核素显像阳性及阴性患者,颈动脉斑块的检出率分别为75％vs50％（P〈0．01）,颈动脉内中膜厚度分别为0．82±0．17VS0．68±0．20（P〈0．01）。结论颈动脉彩超、心脏彩超和心肌核素显像在诊断冠心病中,上述三种方法存在较高的一致性,且以腺苷负荷心肌显像的敏感性最高。     

国产腺苷负荷试验心肌灌注显像对冠心病诊断价值的研究

目的：评价国产腺苷注射液临床应用的药物作用特点、安全性以及腺苷负荷试验对冠心病的诊断价值。方法：将60例疑诊为冠心病的病人随机分为腺苷负荷试验组和运动负荷试验组，各30例。分析腺苷组病人于腺苷注入后的副作用发生情况，并将两种负荷试验所引起的血流动力学变化和对冠心病的诊断价值进行对比。结果：腺苷输注后，73．3％（22／30）病人出现各种副作用，停药后均很快得到缓解。负荷试验后的肺心比值腺苷组小于运动组（P〈0．05），且均低于各自的静息值（P〈0．05）。冠心病检出率腺苷组为65．38％，运动组为72．41％，2组差别不显著。结论：：国产腺苷临床应用安全，可明显增加心肌血流量，腺苷负荷试验对冠心病诊断具有同运动负荷试验相似的价值。     

心肌灌注显像对疑诊冠心病的胸痛患者的诊断价值

目的评估运动负荷实验心肌灌注显像对可疑冠心病的胸痛患者的诊断价值及对冠脉造影病例筛查的价值。方法105例有胸痛、胸闷不适，临床疑诊冠心病的患者，行常规心电图、超声心动图和201T1运动负荷心肌灌注显像，结果与冠状动脉造影检查对比，并分析心肌灌注显像的图象特点。结果心肌灌注显像诊断冠心病的灵敏度、特异性、阳性预测值和阴性预测值分别为91％、82．4％、89．9％、84、8％。心肌灌注异常组，冠脉造影阳性率达91．3％。结论201T1运动负荷心肌灌注显像对胸痛患者有很好的诊断价值，对冠脉造影病例的选择有很好的参考价值。     

超声心外膜脂肪厚度联合心肌分层应变参数预测冠心病患者冠脉狭窄程度

目的 探讨常规超声心动图测量的心外膜脂肪厚度联合心肌分层应变参数对冠心病（CAD）患者冠脉狭窄程度的预测价值。方法 纳入2020年9月—2022年11月于兰州大学第一医院心脏中心行冠脉造影确诊为CAD的患者185例,采用Gensini积分系统对病变冠脉严重程度进行评价,将患者分为轻中度病变组（Gensini积分≤45分,n=89）及重度病变组（Gensini积分＞45分,n=96）。利用二维超声测量收缩末期（EATs）及舒张末期（EATd）心外膜脂肪厚度;采用心肌分层应变技术获取患者左室心内膜下心肌（GLSendo）、中层心肌（GLSmyo）及心外膜下心肌（GLSepi）整体纵向应变,多因素Logistic回归分析冠脉狭窄的影响因素,采用受试者工作特征曲线（ROC）评估EATs、分层纵向应参数及二者联合对CAD患者冠脉狭窄程度的预测价值。结果 与轻中度病变组相比,重度病变组EATs均增厚,GLSendo、GLSmyo、GLSepi均显著降低（P＜0.05）。多因素Logistic 回归分析结果显示,EATs、GLSendo、GLSmyo、GLSepi、HDL-C、BMI、腰围及病变血管数量是冠脉狭窄的独立影响因素（P＜0.05）。EATs、GLSendo、GLSmyo、GLSepi及EATs联合心肌纵向分层应变参数预测CAD患者冠脉狭窄程度的AUC分别为0.729(0.654～0.803)、0.709(0.634～0.785)、0.675(0.594～0.755)、0.673(0.594～0.752)、0.820(0.760～0.880)。结论 随CAD患者冠脉狭窄程度增加,EATs逐步增厚,心肌纵向分层应变参数逐步降低,二者均可预测冠脉狭窄,联合时诊断效能更优     

Assessment of coronary artery disease with second harmonic myocardial perfusion contrast echocardiography

Objectives To assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whether MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD.Methods Thirty-six patients who underwent coronary artery angiography and MCE formed the study groups.Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect.The arteries were classified as normal or diseased.The diseased arteries were classified into three groups according to the perfusion scores.Results There were significant differences in coronary diameter stenosis among the different perfusion score groups (P&lt;0.001).There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation.In the normal perfusion group (Group A), the coronary diameter stenosis was 65%±12%, and the myocardial perfusion score index was 1±0.00.In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82%±8%, and the myocardial perfusion score was 1.93±0.16.The diameter stenosis was less than 85% in 63 % of the coronary arteries (including diameter stenosis ≤75% in 12% of the vessels).The diameter stenosis was 85%-90% in 22% of the coronary arteries and &gt;90% in 15% of the arteries.In the perfusion defect group (Group C), the average diameter stenosis was 90%±6%, and the myocardial perfusion score index was 2.89±0.24.The diameter stenosis was　≥85% in 94% of the coronary arteries, and the diameter stenosis was &lt;85% and &gt;75% only in 6% of the coronary arteries.The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively.The false negative rate was 32.6% for the 108 coronary arteries.Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively.The sensitivity increased with increased lumen diameter stenosis of coronary arteries.Conclusions There is a close relationship between coronary artery stenosis and MCE perfusion scores.MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications.Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated.As artery stenosis increases, the sensitivity of MCE is increased.     

99mTc-MIBI心肌灌注断层显像与冠状动脉造影的对比研究

目的　探讨99mTc-甲氧基异丁基异腈 (MIBI)心肌灌注断层显像对冠心病的诊断价值。方法　 34例99mTc -MIBI心肌灌注断层显像与冠状动脉造影 (CAG)结果进行对比。结果　99mTc-MIBI心肌灌注断层显像对冠心病诊断的敏感性为 91.7%,特异性为 80 .0 %。对右冠状动脉、左冠状动脉前降支和左冠状动脉回旋支的诊断阳性率分别为 85 .7%、92 .3%和 71.4%,总的阳性预测值为 91.7%,阴性预测值为 80 .0 %。结论　99mTc -MIBI心肌灌注断层显像对冠心病的诊断有较大价值。     

Assessment of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery by myocardial contrast echocardiography and two-dimensional strain echocardiography

The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography （RT-MCE） combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu- dinal strain three months after bypass surgery was significantly higher than that before operation [（-15.78±5.91）% vs （-10.45±8.31）%, P〈0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [（-10.33±6.53）% vs （-9.41±6.09）%, P〉0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.     

利用门控心肌灌注显像评价冠状动脉旁路移植术疗效的研究

目的:押探讨心电图门控心肌灌注断层显像在冠状动脉旁路移植术疗效评价上的应用价值。方法押12例冠状动脉旁路移植术的患者,于术前1周内、术后2～4周分别行静息门控单光子发射型计算机断层心肌灌注显像,比较手术前后心肌血流灌注指数、左室射血分数,左室容积、局部室壁运动等的变化,评价冠状动脉旁路移植术的效果。结果:冠状动脉旁路移植术后,平均缺血节段数无明显减少(4.83±1.94vs3.67±2.28,P>0.05),平均灌注指数显著降低(2.17±0.67vs1.20±0.58,P<0.05)。左室射血分数、左室收缩末容积与术前相比,差异无统计学意义,左室舒张末容积与术前相比,差异有统计学意义(98±27mlvs75±24ml,P<0.05)。平均室壁收缩增厚指数明显下降(1.52±0.42vs1.17±0.22,P<0.05)。结论:门控心肌灌注显像能准确评价冠状动脉旁路移植术疗效,为无创性评价冠状动脉旁路移植术的疗效提供了安全、可靠的新途径。