核素心肌灌注显像在左心衰竭与心肌缺血相关性研究中的临床价值

目的利用核素心肌灌注显像,分析左心衰竭与心肌缺血之间的相关性,为临床心力衰竭治疗决策提供重要依据。方法选取临床确诊的各类左心衰竭住院患者75例,其中男性46例,女性29例,年龄35～85岁,平均(60±24)岁,行核素心肌灌注显像,对其中阳性显像追加冠状动脉造影检查。将患者分为心肌灌注显像阴性组和心肌灌注显像阳性组,分别对负荷和静息2次左心室收缩末期容积、舒张末期容积进行行×列表χ2检验,观察缺血面积与心室容量整体的相互差异。同时对其中符合临床支架植入指征的30例患者进行了冠状动脉支架植入术,术后21例复查了核素心肌灌注显像并与术前进行了对比分析。结果核素心肌灌注显像结果无明显异常者15例,轻度缺血15例,中度缺血36例,且均为负荷显像阳性,静息显像阴性的可逆性缺血;严重缺血9例,均为负荷、静息显像阳性的不可逆性缺血。缺血面积百分比为(15±10)%,严重程度标准差值平均为-2.7±1.8,射血分数(EF)值为(43±8)%。不同缺血范围水平级的左心室容积和缺血范围,按α=0.05检验水准,呈现缺血越严重,心室容积越大趋势,心室射血功能也相应下降。缺血面积与负荷舒张末期容积、静息舒张末期容积、负荷收缩未期容积、静息收缩末期容积的相关系数(r值)分别为0.68、0.70、0.65、0.73,P值均<0.01。60例核素心肌灌注显像阳性组患者行冠状动脉造影检查,结果为46例有不同程度狭窄(≥50%)。21例支架植入术后患者左心室容量恢复具有统计学意义(P<0.05)。结论核素心肌灌注显像为临床早期判断左心衰竭病因,从而做出及时正确的决策有着重要临床意义。

The clinical value of nuclide myocardial perfusion imaging on the correlations between left ventricular failure and myocardial is chemia perfusion

Objective To study the relationship between left ventricular failure and myocardial ischemia by nuclide myocardial perfusion imaging to provide important evidence for clinical early therapeutic decision-making.Methods Seventy-five hospitalized cases with clinical definite diagnosis of left ventricular failure,including 46 males and 29 females aged 35~75 years(60±24),were checked through nuclide myocardial perfusion imaging.Positive patients were checked by coronary arteriography(CAG).Patients were divided into the positive and the negative of nuclide myocardial perfusion imaging were do χ2 test for end-systolic volume and end-iastolic dimension of stress and observed integral difference between ischemic area and vascular capacitance.Simultaneously,the patients consistent with clinical indication were undergone angioplasty,rechecked by nuclide myocardial perfusion imaging postoperatively and contrastingly analyzed with the preoperative.Results Negative nuclide myocardial perfusion imaging were 15 cases,15 cases of light ischemia,36 cases midrange ischemia,all the cases were positive stress imaging;9 cases of severity ischemic,all the cases were positive stress and rest imaging.Ischemic area percentage was(15±10)%,severity degree standard deviation was-2.7±1.8,ejection fraction(EF)were(43±8)%.In different level,according to α=0.05 size of test,left ventricular volume and ischemic area show ischemic the more serious,heart ventricle volume the more augmentation,ventricular ejection function correspondingly descended,too.Correlation coefficient(r)of ischemic area with stress end-diastolic dimension and rest end-diastolic dimension and stress end-systolic volume,rest end-systolic volume were 0.68,0.70,0.65,0.73(P<0.01),respectively.Sixty patients with positive nuclide myocardial perfusion imaging were checked CAG,there was 46 patients of different degree narrowness(≥50%).Left vascular capacitance resume of patients undergoing postoperative angioplasty had statistical significance(P<0.05).Conclusion Nuclide myocardial perfusion imaging had positive significance in judging early etiological factor and making correct decision in left ventricular failure diagnosis.