静息心肌灌注显像判断梗塞相关动脉的作用

目的　评价静息心肌显像的缺血缺损部位对于判断梗塞相关动脉 (IRA)的价值。方法对 44例心肌梗死患者进行99Tcm 甲氧基异丁基异腈 (MIBI)静息心肌断层显像和冠状动脉造影(CAG)。结果　CAG提示IRA 44支 ,其中左前降支 (LAD) 2 7支 ,左旋支 (LCX) 9支 ,右冠脉 (RCA) 8支。当IRA是LAD时出现间壁受累 ,IRA是LCX时出现侧壁受累和IRA是RCA时表现下后壁受累的意义较大 (χ2 =8.98和 8.96 ,P均 <0 .0 5 ;χ2 =43.82 ,P <0 .0 0 5 )。前壁、心尖部、间壁和广泛前壁稀疏缺损对于判断IRA LAD的灵敏度较高 ,分别是 89% ,86 % ,80 %和 89% ;特异性以间壁最高 ,达 80 % ;侧壁和后侧壁判断IRA LCX的灵敏度和特异性分别是 75 % ,6 7%和 85 % ,83% ;下后壁病变判断IRA RCA的灵敏度和特异性分别是 71%和 91%。结论　心肌灌注显像对于判断心肌梗死的IRA有一定价值

Evaluation of the role of infarct_related artery in myocardial infarction by resting myocardial perfusion imaging

Objective Resting myocardial perfusion tomographic imaging with 99Tc m-MIBI for the assessment of infarct-related artery (IRA)in a group of myocardial infarction patients. Methods Forty-four cases with myocardial infarction were studied. Resting 99Tc m-MIBI myocardial perfusion imaging plus coronary angiography were performed. Results There were 44 IRA including anterior descending branches (LAD) 27(61.4%), left circumflex branches (LCX) 9(20.5%) and right coronary artery branches (RCA)8 (18.2%) involved. The sensitivity of anterior wall and extend anterior wall defects of left ventricular in detecting IRA was 89% and 89%,respectively. The septum wall defects had specificity of 80% for evaluation IRA-LAD. The lateral wall and postero-lateral wall defects had the sensitivity and specificity of 75%, 67%, 85%and 83% for determining IRA-LCX, respectively. The infero-posterior wall defects had a sensitivity of 71%, a specificity of 91% for diagnosis of IRA-RCA. Conclusions Resting myocardial perfusion imaging is an accurate method for the diagnosis and localization of IRA in patients with myocardial infarction. The technique provides a high specificity and sensitivity for the diagnosis of IRA.