心尖肥厚型心肌病^(99)Tc^m-甲氧基异丁基异腈心肌血流灌注显像及左心室扭转的初步研究  

Evaluation of ^(99)Tc^m -methoxy isobutyl isonitrile myocardial perfusion imaging and left ventricular twisting in patients with apical hypertrophic cardiomyopathy

作　　者：杨承健[1] 叶新和[1] 冯雪红[1] 由春媛[1] 徐欣[1] 曹佳宁[1] 董丰[1] 王仁荣[1] 胡大一[2] 

机构地区：[1]南京医科大学附属无锡第二医院心内科,江苏无锡214002 [2]北京大学人民医院心脏中心

出　　处：《中华高血压杂志》2014年第2期163-168,共6页Chinese Journal of Hypertension

摘　　要：目的探讨心尖肥厚型心肌病(ApHCM)99 Tcm-甲氧基异丁基异腈(MIBI)心肌血流灌注显像及左心室扭转的特点。方法应用99 Tcm-MIBI心肌血流灌注显像及速度向量成像技术(VVI)对21例ApHCM患者进行静息和负荷核素心肌显像观察,另入选超声正常对照组21人;VVI对ApHCM患者左心室短轴心底及心尖水平的心内膜下心肌扭转和解旋等行定量分析。结果 ApHCM患者21例中,有18例静息下核素心肌灌注基本正常;而腺苷负荷下21例均显示心肌前壁近心尖部位心肌灌注稀疏或缺损,18例为可逆性灌注缺损,2例为部分可逆性灌注缺损,1例呈反向再分布。ApHCM患者心尖部心肌厚度明显高于正常对照组[(17.1±3.6)比(9.0±1.8)mm,P<0.05];ApHCM组左心室短轴心尖部心内膜下心肌收缩期峰值旋转角度[(5.3±2.6)°比(10.1±2.7)°]、旋转速度[(74.9±18.9)%比(99.2±17.7)°/s]及左心室扭转角度[(10.8±2.2)°比(15.8±2.6)°]均低于正常组(均P<0.05);而两组间心底部心内膜下心肌收缩期峰值旋转角度、旋转速度差异无统计学意义(P>0.05);ApHCM组舒张早期左心室心底部与心尖部心内膜下心肌的峰值解旋速度低于正常组(均P<0.05)。结论 ApHCM患者腺苷负荷显示,心肌前壁近心尖部位心肌灌注稀疏或缺损,ApHCM患者左心室心内膜下心肌的扭转角度及解旋运动减低。Objective To investigate the features of 99 Tcm methoxy isobutyl isonitrile （MIBf）myocardial perfusion imaging and left ventricular twisting in patients with apical hypertrophic cardiomyopathy （ApHCM）. Methods Twenty-one patients with ApHCM were received resting and adenosine-stress myocardial perfusion ima- ging by 99Tcm-MIBI and velocity vector imaging （VVI） , and 21 healthy subjects were included. The subendocardial ventricular twisting and untwisting were measured in left ventricular apical and basal views by VVI. Results Eighteen of the 21 patients with ApHCM had normal resting myocardial perfusion. Using adenosine-stress perfu- sion imaging, the perfusion defects in 21 patients with ApHCM were found in the left ventricular anterior wall and close to the apex, including 18 cases of reversible perfusion defect, 2 cases of partially reversible perfusion defect and 1 case with reverse distribution. The apical myocardial thickness of ApHCM patients were evidently greater than that of normal group [（17.1±3.6） vs （9.0±1. 8）mm, P〈0.05]. The peak systolic twist angle [（5.3±2.6）°vs （10. l±2. 7）°, P〈0.05] and twist velocity [（74.9±18.9） vs （99.2±17.7）°/s, P〈0.05] of the left ventricular apical subendocardium and the left ventricular torsion angle [ （ 10.8 ±2.2 ）° vs （ 15.8 ±2.6 ）°, P 〈 0.05 ] were markedly lowered in ApHCM patients, but the peak systolic twist angle and twist velocity of the left ventricular basal subendocardium were of no statistic significance （P〉0.05） compared with those in control group. In early diastolic, the peak untwisting velocity at left ventricular apical and basal slices were also significantly decreased in ApHCM patients （P〈0.05） compared with the control group. Conclusions Patients with ApHCM showed perfu- sion defect in left ventricular anterior wall after adenosine stress, which was close to the apex, and the twist angel and untwisting velocity were decreased at the left ventricular subendocardial layers.

关 键 词：心尖肥厚型心肌病 核素心肌显像 速度向量成像 扭转 解旋 

分 类 号：R542.2[医药卫生—心血管疾病]