心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值

目的 探讨核素心肌灌注显像(myocardial perfusion imaging, MPI)半定量分析不同缺血程度对老年冠状动脉粥样硬化性心脏病(coronary artery disease, CAD,以下简称冠心病)的诊断价值。方法 以2017年8月至2020年6月于民航总医院行两日法静息-负荷心肌灌注显像的99例患者为研究对象,所有患者均于6个月内行冠状动脉造影(coronary angiography, CAG),根据CAG结果分为冠心病组52例(病例组)和非冠心病组47例(对照组)。收集患者的一般临床资料、MPI静息总评分(summed rest score, SRS)、负荷总评分(summed stress score, SSS)、静息-负荷差值评分(summed difference score, SDS)及CAG结果进行分析。组间均数比较采用t检验,率比较采用χ²检验,多因素分析采用多因素Logistic回归分析。结果 99例患者平均年龄为(67.24±5.18)岁,其中男性53例,女性46例。SSS及SDS均为冠心病的独立危险因素,OR值分别为(7.425, 95%CI: 2.873~19.192, P＜0.001) 及(8.020, 95%CI: 2.980~21.984, P＜0.001)。心肌血流灌注异常(SSS＞3)诊断CAD的一致性,优于心肌血流灌注异常与心肌不同缺血情况的联合实验。结论 MPI半定量分析SSS及SDS是老年冠心病的独立危险因素,但SSS联合SDS不同缺血情况不能提高老年冠心病的诊断效能。

Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease

Objective To evaluate the value of different thresholds of myocardial perfusion and ischemia scores obtained from myocardial perfusion imaging (MPI) in diagnosing in elderly persons with suspected coronary artery disease. Methods A total of 99 patients [mean age (67.24±5.18) years, 53 male and 46 female] who underwent two-day rest-stress MPI in Department of Nuclear Medicine, Civil Aviation General Hospital from August 2017 to June 2020 were enrolled, and the data were analyzed retrospectively. According to coronary angiography (CAG) results, the patients undergoing CAG within 6 months were divided into coronary artery disease (CAD) group(patients group, 52 cases) and non-CAD group (control group, 47 cases). The general clinical information, summed rest score (SRS), summed stress score (SSS) and summed difference score (SDS) were collected. t test and χ² test were used to compare the data between the different groups. Multivariate Logistic regressions were used to establish the independent diagnostic value and accuracy of MPI parameters. Results In multivariate analysis accounting for clinical variables associated with CAD, both SSS (7.425, 95%CI: 2.873-19.192, P＜0.001) and SDS (8.020, 95%CI: 2.980-21.984, P＜0.001) were independently related with CAD. The consistency of SSS＞3 in the diagnosis of CAD is better than the different threshold of myocardial perfusion combined with ischemia. Conclusion The myocardial perfusion and ischemia scores from MPI are independent risk factors for predicting CAD in the elderly persons, but SSS combined with different SDS thresholds could not improve the diagnostic efficiency of elderly persons with suspected coronary disease.