LDDE和含服硝酸甘油^(99m)Tc-MIBI心肌灌注显像对血管重建术后存活心肌的评估  

ASSESSMENT OF VIABLE MYOCARDIUM BY LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY AND SUBLINGUAL NITROGLYCERIN ^(99m)Tc-MIBI SPECT AFTER REVASCULARIZATION

作　　者：李宪伦[1] 郑知刚[1] 张小平[1] 马步成[2] 马长生[1] 柯元南[1] 

机构地区：[1]中日友好医院心内科,北京100029 [2]中日友好医院核医学科,北京100029

出　　处：《中日友好医院学报》2000年第2期71-75,共5页Journal of China-Japan Friendship Hospital

基　　金：中日友好医院院级课题

摘　　要：目的 :采用低剂量多巴酚丁胺超声心动图 (LDDE)和含服硝酸甘油 (NTG)介入99mTc MIBI心肌灌注显像评价血管重建术前后的心肌存活性 ,并进行对比分析。方法 :将 37例心肌梗塞患者分为 3组 ,于血管重建术前分别行LDDE和 /或NTG介入99mTc MIBI心肌灌注显像 ,术后 1个月行基础超声心动图或静息99mTc MIBI心肌显像。结果 :Ⅰ组 ,NTG介入99mTc MIBI心肌灌注显像对术后心肌灌注改善的阳性预测值为 86 1 % ,阴性预测值为 79 2 % ,准确率为 82 6% ;Ⅱ组 ,LDDE对术后室壁运动改善的阳性预测值为 82 5% ,阴性预测值为 81 1 % ,准确率为 81 6% ;Ⅲ组 ,2种方法对低动力心肌节段功能恢复的预测无显著差异 (P >0 0 5) ;而对无动力心肌节段差异显著 (P <0 0 5) ;LDDE和NTG介入99mTc MIBI心肌灌注显像对整个运动障碍节段功能恢复预测的敏感性分别为 70 2 %和84 9% ,特异性分别为 87 2 %和 68 2 %。结论 :LDDE和NTG介入99mTc MIBI心肌灌注显像均是临床检测心肌存活安全、有价值的方法 ,如以术后室壁运动改善作为存活心肌的标准 ,则LDDE有较高的特异度。Objective:To evaluate the value of low dose dobutamine echocardiography(LDDE) and nitroglycerion 99 m Tc MIBI SPECT(single photon emission computed tomography) in assessment of myocardial viability.Methods:Thirty seven patients with myocardial infarction were divided into three groups,LDDE and NTG 99 m Tc MIBI SPECT were performed before revascularization,and baseline echocardiography or rest 99 m Tc MIBI SPECT were completed one month after revascularization.Results:In Group Ⅰ,the positive predictive value(PPV) of pre Revasc NTG 99 m Tc MIBI SPECT for post Revasc improvement,negative predictive value(NPV),and accuracy were 86 1%,79 2% and 82 6% respectively.In Group Ⅱ,the PPV of LDDE for post Revasc improvement in segments of dysfunction,NPV and accuracy were 82 5%,81 1% and 81 6% respectively.In Group Ⅲ,no significant difference between the two methods was found in predicting functional recovery of hypokinetic segments,but there was significant difference( P <0 05) in akinetic segments.In all three groups of dysfunctional segments,LDDE showed sensitivity of 70 2% and specificity of 87 2%,NTG 99 m Tc MIBI SPECT demonstrated sensitivity of 84 9% and specificity of 68 2%.Conclusion:LDDE and NTG 99 m Tc MIBI SPECT were safe and reliable methods for identifying viable myocardium.LDDE had a better specificity than NTG 99 m Tc MIBI SPECT in predicting improvement of wall motion.

关 键 词：心肌梗塞 心肌 多巴酚丁胺 LDDE 核医学 

分 类 号：R540.4[医药卫生—心血管疾病]