药物负荷超声心动图与双核素心肌显像对比检测存活心肌  

Head to head comparison of dobutamine alone and combined with nitrate stress echocardiography and ^(99)mTc-MIBI/ ^(18)FDG myocardial SPECT image for diagnosis of viable myocardium in patients with severe left ventricular dysfunction

作　　者：杨跃进[1] 杨伟宪[1] 史蓉芳[1] 胡奉环[1] 尤士杰[1] 田月琴[1] 何作祥[1] 王燕武[1] 叶苓[1] 陈纪林[1] 高润霖[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院冠心病诊治中心,北京100037

出　　处：《中华心血管病杂志》2005年第4期323-327,共5页Chinese Journal of Cardiology

摘　　要：目的　比较99mTc 甲氧基异丁腈(MIBI) /18F 脱氧葡萄糖(FDG)双核素同时采集法(DISA)单光子发射型断层显像(SPECT)和药物负荷二维超声心动图(2DE)试验,识别冠心病左心室收缩功能严重减低患者[左室射血分数(LVEF)≤45% ]存活心肌的准确性。方法　陈旧性心肌梗死患者26例,平均LVEF(38. 6±4 .9 )%,在一周内分别进行小剂量多巴酚丁胺10μg·kg-1·min-1(Dob10μg)、亚硝酸异山梨酯合用Dob5μg·kg-1·min-1 (ISDN Dob5μg)的2DE试验,以及DISASPECT心肌显像。所有患者在冠状动脉血管重建(CRV)术后(6 .8±2 .9)个月完成了2DE复查。采用16节段半定量法分别分析图像,以CRV术后收缩功能改善节段为存活标准,比较两种方法检测存活心肌的敏感性、特异性和准确性。结果　26例患者272个运动异常节段中,术后156个( 57. 4% )有收缩运动改善。DISASPECT检测出72 .4% (134 /254)存活心肌节段,显著高于术后实际改善率(P<0 .001)。Dob10μg2DE的存活心肌检出率为65 5% (163 /249 ),ISDN Dob5μg2DE的为65 .7%(176 /268),均与术后实际改善率一致(P均>0 .05)。DISASPECT检测存活心肌的敏感性、特异性和准确性分别为93%, 55%和76. 8%;Dob10μg2DE的分别为88 .6%, 64 .2%和77. 9%,两种方法检测效果相当(P均>0 .05)。ISDNObjective This study was sought to compare the sensitivity, specificity and accuracy of (1) dual isotope simultaneous acquisition single-photon emission computed tomography (DISA SPECT) myocardial image with 99m Tc-sestamibi/ 18F-fluorodeoxyglucose ( 99mTc-MIBI / 18FDG); (2) low dose dobutamine alone and combined with Isosorbide Dinitrate (ISDN: Isoket) stress two dimensional echocardiography(2DE) to predict regional movement recovery after revascularization (CRV) in patients with old myocardial infarction (OMI) and severe left ventricular dysfunction.Methods Twenty-six patients (mean age 51±8 years, male 25, female 1) with OMI and severe left ventricular dysfunction (mean left ventricular ejection fraction, LVEF (38.6%±4.9%) underwent low dose dobutamine 10 μg·kg -1·min -1(Dob10 μg) and ISDN (286 ±31 μg/min) combined with Dob5 μg (ISDN-Dob 5 μg)2DE and DISA SPECT within one week. In echocardiogram and DISA SPECT images: the left ventricle (LV) was divided into 16 segments. The semi-quantitative scoring system was used for both images. Myocardial viability was defined as an improvement of at least ≥1 grade in at least two contiguous segments at rest 2DE after CRV. The viable segments detecting rate with stress 2DE and DISA SPECT were compared. Compared with the results of post-CRV, the sensitivity, specificity and accuracy of detecting viable segments of two methods were calculated.Results Among 272 abnormal segments in 26 patients, 156(57.4%) segments showed contractile improvement after CRV. The viable segments detecting rate with DISA SPECT was 72.4%(134/254), which was significantly higher than the contractile improved rate after CRV(P<0.001). During Dob10 μg2DE and ISDN-Dob5 μg 2DE, the detecting rates were 65.5%(163/249) and 65.7%(176/268), respectively, which were both comparable to the improved rate after CRV(both P>0.05). With DISA SPECT, the sensitivity, specificity and accuracy were 93.7%, 55% and 76.8%, respectively. Compared with DISA SPECT, Dob10 μg2DE showed similar sensit

关 键 词：存活心肌 药物负荷超声心动图 双核素心肌显像 对比检测 ^18F-脱氧葡萄糖 左心室收缩功能 SPECT心肌显像 DISA 二维超声心动图 检测效果 单光子发射型 甲氧基异丁腈 左室射血分数 心肌梗死患者 硝酸异山梨酯 CT检测 2DE 

分 类 号：R540.4[医药卫生—心血管疾病]