门控心肌灌注显像定量分析评价心肌梗死后左心室重构及其对心功能的影响  

Gated Myocardial Perfusion Imaging Quantitative Analysis Technique in Evaluation of Left Ventricular Remodeling and Its Effect on Cardiac Function After Myocardial Infarction

作　　者：王建锋[1] 王跃涛[1] 牛荣[1] 邵晓梁[1] 张云[1] 陈海龙[1] 储懿[1] 陆培奇 

机构地区：[1]江苏省常州市第一人民医院核医学科,江苏常州213003

出　　处：《中国医学影像学杂志》2014年第10期749-753,共5页Chinese Journal of Medical Imaging

基　　金：江苏省卫生厅科技项目(H201349);江苏省常州市科技项目(CJ20112007)

摘　　要：目的探讨门控心肌灌注显像（GMPI）定量分析技术评价心肌梗死（MI）患者左心室重构的临床价值及其对左心功能的影响。资料与方法回顾性分析76例MI患者,包括左前降支（LAD）病变组21例、左旋支（LCX）或右冠支（RCA）病变组23例、多支病变组32例,选择74例健康人为对照组。所有受检者均进行GMPI。应用QGS 2009软件对重建后的图像进行自动分析,获得左心室重构指标：舒张末期球形指数（SIED）和收缩末期球形指数（SIES）;并获得心功能参数：舒张末期容积（EDV）、收缩末期容积（ESV）、左心室射血分数（LVEF）、高峰充盈率（PFR）。比较MI组与对照组左心室重构指标和心功能参数,分析心肌梗死后左心室重构与冠状动脉病变的关系。结果 MI组SIED、SIES、EDV、ESV较对照组均明显升高（P〈0.01）,LVEF、PFR较对照组明显降低（P〈0.01）。LAD病变组及多支病变组之间SIED、SIES无显著差异（P〉0.05）,但均较LCX/RCA病变组明显升高（P〈0.05）;LAD病变组与多支病变组发生左心室重构的概率差异无统计学意义（χ2=0.105,P〉0.05）,但两组发生左心室重构的概率明显高于LCX/RCA病变组（χ2=6.502、10.166,P〈0.05）。线性回归分析显示随SIED值增高,LVEF、PFR呈下降趋势（F=43.231、15.642,P〈0.01）。左心室重构定量指标SIED和SIES在同一操作者及两名操作者之间的处理分析结果均呈高度相关（r=0.881-0.926,P〈0.01）。结论 GMPI定量分析技术可准确评价心肌梗死后左心室重构,LAD病变及多支冠状动脉病变所致心肌梗死患者更易发生左心室重构且程度重,左心室重构会严重影响心肌的收缩和舒张功能,从而导致整个左心功能受损。Purpose To investigate the clinical value of gated myocardial perfusion imaging（GMPI） quantitative analysis technique in evaluating left ventricular remodeling and its effects on left ventricular function in patients with myocardial infarction（MI）. Materials and Methods Seventysix cases of MI patients were retrospectively analyzed, including pure left anterior descending artery（LAD） disease in 21 cases, left circumflex artery（LCX） or right coronary branch（RCA） disease in 23 patients and multivessel disease in 32 cases. Seventy-four healthy people were additionally selected as control group. GMPI was performed on all subjects. Reconstruction images were automatically analyzed by using cardiac software QGS 2009 to obtain left ventricular remodeling index, including diastolic sphericity index（SIED） and end-systolic sphericity index（SIES）. Cardiac function parameters were also obtained, including left ventricular end-diastolic volume（EDV）, end-systolic volume（ESV）, left ventricular ejection fraction（LVEF）, and peak filling rate（PFR）. Differences of the left ventricular remodeling index and cardiac function parameters between the MI group and the control group were compared to analyze the relationship between left ventricular remodeling after myocardial infarction and coronary artery lesions. Results SIED, SIES and EDV, ESV in MI group were significantly higher than those in the normal group（P〈0.01）. The cardiac function parameters of LVEF and PFR were significantly lower than those of the normal group（P〈0.01）. SIED and SIES in the group of LAD lesions and multi-vessel disease were significantly higher than those in the LCX/RCA lesion group（P〈0.05）. The left ventricular remodeling was occurred more often in LAD lesion group and multi-vessel disease group than in the LCX/RCA lesion group（χ2=6.502 and 10.166, P〈0.05）. There was no significant difference between the LAD lesions group and multi-vessel disease group（χ2=0.105, P〈0.05）. Linear regres

关 键 词：心肌梗死 门控血池显像 心肌再灌注 灌注成像 心室功能 左 

分 类 号：R542.22[医药卫生—心血管疾病] R814.43[医药卫生—内科学]