平板运动试验与双核素心肌显像检测存活心肌的对比研究

目的采用99mTc-甲氧基异丁基异腈（MIB）I/18F-脱氧葡萄糖（FDG）双核素SPECT心肌显像与平板运动试验对陈旧性心肌梗死患者存活心肌检测进行比较,探讨平板运动试验评价陈旧性心肌梗死患者存活心肌的可行性及临床价值.方法选择确诊的陈旧性心肌梗死患者45例,所有患者均行99mTc-MIBI/18F-FDG双核素SPECT及平板运动试验检查.根据99mTc-MIBI/18F-FDG双核素SPECT显像结果判定存活心肌,将患者分为两组,即心肌存活组与心肌无存活组.比较平板运动试验各项指标在两组间的变化,分别计算其识别存活心肌的敏感性、特异性和准确性.结果 45例患者中24例为心肌存活组（n=24）,21例为心肌无存活组（n=21）;心肌存活组中87.5%（21/24）Q波延长,75.0%（18/24）QT离散度≤70 ms;Q波延长判断心肌存活的敏感性、特异性和准确性分别是87.5%、85.7%和86.7%,QT离散度≤70 ms判断心肌存活的敏感性、特异性和准确性分别是75.0%、71.4%和60.0%.结论在陈旧性Q波型心肌梗死单支病变患者中,平板运动试验指标Q波延长和QT离散度检测存活心肌具有较高的敏感性和特异性.

Comparison of Treadmill Exercise Test and 99mTc-MIBI/18F-FDG Myocardial SPECT Image for Identifying Viable Myocardium in Patients with Old Myocardial Infarction

Objective To compare treadmill exercise test and 99mTc-MIBI/18F-FDG dual isotope simultaneous acquisition of single photon emission computed tomography（SPECT）in assessing the myocardial viability in old myocardial infarction,and to explore the feasibility and clinical value of treadmill exercise test.Methods 45 consecutive patients with old myocardial infarction underwent coronary arteriography,treadmill exercise testing and 99mTc-MIBI/18F-FDG dual isotope simultaneous acquisition of SPECT.Patients were classified into myocardial viability group and non myocardial viability group according to 99mTc-MIBI/18F-FDG SPECT.The indices of treadmill exercise testing were measured and compared between the two groups,the sensitivity,specificity,and accuracy of these indices for detecting myocardial viability were calculated.Results 24 out of the 45 studied patients were defined in myocardial viability group,and the rest of 21 patients were in not myocardial viability group.87.5%（21/24）patients in myocardial viability group were accompanied with exercise-induced Q-wave prolongation.Myocardial viability was detected more often in patients（75%）with smaller QT dispersion（≤70 ms）.The sensitivity,specificity,and accuracy of Q-wave prolongation for evaluating myocardial viability were 87.5%,85.7%,and 86.7% respectively.The sensitivity,specificity,and accuracy of QT dispersion≤70 ms were 75.0%,71.4%,and 60.0 %,respectively.Conclusion In patients with old myocardial infarction,Treadmill exercise-induced Q-wave prolongation and QT dispersion are the sensitive and specific ECG markers for detecting of myocardial viability.