双核素心肌显像对老年冠心病CTO病变PCI术的指导意义

目的评价99 Tcm-甲氧基异丁基异腈（99 Tcm-sestamibi,99 Tcm-MIBI）/18F脱氧葡萄糖（18F-fluorodeoxy glu-cose,18F-FDG）双核素心肌灌注/代谢显像技术（DISA）检测冠状动脉完全闭塞导致心力衰竭型冠状动脉粥样硬化性心脏病老年患者存活心肌对经皮冠状动脉支架术（Percutaneous coronary intervention,PCI）后心功能的改善情况。方法 41例经冠状动脉造影证实至少1支以上冠脉闭塞导致心力衰竭型冠心病的老年患者,PCI术前1周行99 Tcm-MI-BI/18F-FDG双核素心肌灌注/代谢显像检查,根据DISA结果,分为有心肌存活组和无心肌存活组。分别比较PCI术前后2组患者血浆BNP值及左室射血分数（LVEF）等心功能指标。结果有心肌存活组经PCI术后LVEF由41.12±5.97升至47.12±4.86,LVFS由16.79±5.64升至25.86±7.43,血NT-proBNP值由4287.25±401.56ng/L降至427.43±91.47ng/L;术前与术后比较,有显著统计学意义;无心肌存活组经PCI术后LVEF由40.03±3.48升至41.31±3.56,LVFS由16.35±5.86升至18.75±3.51,血NT-proBNP值由4495.32±347.72ng/L降至3827.53±97.28ng/L,术前与术后比较,无统计学意义。结论双核素心肌显像能有效检测冠状动脉完全闭塞致心力衰竭型冠心病老年患者存活心肌,而有存活心肌者PCI术后心功能得到明显改善。故双核素心肌显像对老年冠心病CTO病变行PCI术有指导意义。

The significance of DISA in elderly with heart failure of CTO lesions underwent PCI

Objective To evaluate the significance of radionuclide myocardial perfusion/metabolic imaging technolo- gy（99 Tcm-sestamibi/18F_fluorodeoxy_glucose） on detection viable myocardium of clinical coronary occlusion leading tb heart failure in elderly patients about improving heart function after PCI. Methods 41 cases confirmed by coronary an- giography at least one coronary artery occlusion, leading to heart failure coronary artery disease in elderly patients, weeks of PCI preoperative,after 99 Tcm-MiBi/18F-deoxyglucose dual-core prime myocardial perfusion/ imaging exami- nation,according to DISA results cases was divided into preoperative and postoperative group and myocardial no viabili- ty group, two groups of patients were compared before and after PCI plasma BNP levels and left ventricular ejection fraction. Results Myocardial viability group after PCI I.VEF from 41.12±5.97 to 47. 12 ± 4.86, and the LVFS from 16.79±5.64 to 25.86±7.43;serumNT-proBNP values decreased from 4287.25±401.56 ng/L to 427.43-±91.47 ng/ L. preoperative and postoperative comparison was statistically significant; to myocardial viability no group after PCI, LVEF from 40.03± 3.48 to 41.31±3.56, the LVFS from 16.35 ± 5.86 to 18.75 ± 3.51, serum NT-pro BNP value de- creased from 4495.32±347.72 ng/1 to 3827.53 ±97.28 ng/1,preoperative and postoperative comparison was not sta- tistically significant. Conclusion DISA can effectively detect viable myocardium of coronary occlusion induced heart failure coronary heart disease in elderly patients . the heart function of myocardial viability was significantly improved after PCI. the duabradionuclide myocardial perfusion/metabolic imaging is guidance of PCI of elderly coronary heart CTO lesions.