CT负荷心肌灌注中心率反应与灌注异常的相关性  

Correlation Between Heart Rate Response and Abnormal Myocardial Blood Flow in CT Myocardial Perfusion Imaging

作　　者：朱萌萌 徐怡[1] 朱晓梅[1] 施海彬[1] 祝因苏[1] 李新立[2] ZHU Mengmeng;XU Yi;ZHU Xiaomei;SHI Haibin;ZHU Yinsu;LI Xinli(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京医科大学第一附属医院心内科,江苏南京210029

出　　处：《中国医学影像学杂志》2021年第2期148-151,157,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨三磷酸腺苷(ATP)负荷下心率反应与心肌灌注异常之间的相关性,比较心率增加绝对值和相对值在预测心肌缺血中的价值。资料与方法纳入76例怀疑冠心病行CT心肌灌注检查(CT-MPI)的患者,任一节段心肌血流量(MBF)<120 ml/(min·100 ml)定义为灌注异常,共33例。计算ATP负荷前后心率增加的绝对值和相对值,以心率增加绝对值的中位数(15次/min)为界,分为绝对值变化较小组34例和较大组42例。通过受试者工作特征(ROC)曲线评价心率增加预测心肌缺血的诊断效能。结果灌注异常组的心率增加绝对值小于灌注正常组[(15±9)次/min比(21±9)次/min,P<0.05];两组心率增加相对值比较,差异无统计学意义(P>0.05)。绝对值变化较小组心肌灌注异常的比例更高[59%(20/34)比31%(13/42),P<0.05],MBF更低[(151.4±26.3)ml/(min·100 ml)比(165.6±28.7)ml/(min·100 ml),P<0.05]。ROC曲线显示,心率增加绝对值判断心肌缺血的最佳界值是12次/min,敏感度为48.5%,特异度为88.4%,准确性为71.1%。结论心肌缺血患者对ATP的心率反应变钝,心率增加绝对值对心肌缺血有一定的预测价值。Purpose To explore the association between heart rate response to adenosine triphosphate(ATP)and abnormal myocardial perfusion,and compare the efficiency of absolute and relative values of heart rate increase in predicting myocardial ischemia by computed tomographic myocardial perfusion imaging(CT-MPI).Materials and Methods Seventy-six patients suspected as coronary arterial disease underwent CT-MPI.Patients with myocardial blood flow(MBF)less than 120 ml/(min·100 ml)in at least 1 segment was classified as ischemic group(n=33).The absolute and relative values of heart rate increase due to ATP were calculated.The enrolled patients was divided into dull(n=34)and sensitive heart rate response cohorts(n=42)according to median value of absolute heart rate increase(15 beats/min).Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of heart rate increase in predicting myocardial ischemia.Results The absolute value of heart rate increase in the ischemic group was smaller than that in the non-ischemic group[(15±9)beats/min vs.(21±9)beats/min,P<0.05],while the relative value of heart rate increase showed no statistical difference between the two groups(P>0.05).Compared with the sensitive heart rate response cohort,the dull heart rate response cohort had significantly higher rate of ischemia[59%(20/34)vs.31%(13/42),P<0.05]and lower average MBF[(151.4±26.3)ml/(min·100 ml)vs.(165.6±28.7)ml/(min·100 ml),P<0.05].According to the ROC curve,the cut-off value was 12 beats/min for diagnosing myocardial ischemia,the corresponding sensitivity,specificity and accuracy was 48.5%,88.4%and 71.1%,respectively.Conclusion Heart rate response to ATP is dulled in patients with myocardial ischemia.The absolute value of heart rate increase may predict the myocardial ischemia.

关 键 词：心肌缺血 血流动力学 体层摄影术 X线计算机 心肌灌注显像 

分 类 号：R445.3[医药卫生—影像医学与核医学] R541[医药卫生—诊断学]