门控心肌灌注显像评价急性心肌梗死早期左心室舒张不同步及其影响因素的实验研究  

Assessment of left ventricular diastolic dyssynchrony and its influencing factors early after acute myocardial infarction by SPECT gated myocardial perfusion imaging:an experimental study

作　　者：张飞飞 王建锋[1] 邵晓梁[1] 杨晓宇[2] 徐敏[3] 万鹏 范圣登[4] 史云梅 俞雯吉 刘保 李小霞 徐梅[1] 陈佳恬 王跃涛[1] Zhang Feifei;Wang Jianfeng;Shao Xiaoliang;Yang Xiaoyu;Xu Min;Wan Peng;Fan Shengdeng;Shi Yunmei;Yu Wenji;Liu Bao;Li Xiaoxia;Xu Mei;Chen Jiatian;Wang Yuetao(Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou Key Laboratory of Molecular Imaging,Changzhou 213003,China;Department of Cardiology,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou 213003,China;Department of Echocardiography,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou 213003,China;Department of Anesthesiology,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科、常州市分子影像重点实验室,常州213003 [2]苏州大学附属第三医院、常州市第一人民医院心血管内科,常州213003 [3]苏州大学附属第三医院、常州市第一人民医院心超室,常州213003 [4]苏州大学附属第三医院、常州市第一人民医院麻醉科,常州213003

出　　处：《中华核医学与分子影像杂志》2022年第3期154-159,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81871381,81901777,81701737);常州高技术研究重点实验室(CM20193010);常州市卫生健康委青年人才科技项目(QN201920);常州市卫生健康青苗人才培养工程(CZQM2020002)。

摘　　要：目的应用SPECT门控心肌灌注显像(GMPI)相位分析评价急性心肌梗死(AMI)早期左心室舒张不同步(LVDD)及其影响因素。方法取16头巴马小型猪建立AMI模型,分别于建模前及AMI后1 d行GMPI,经定量分析获得心肌灌注缺损范围占左心室的百分比(Extent,%)、左心室收缩不同步(LVSD)及LVDD参数[相位直方图带宽(PBW)和相位标准差(PSD)];同期行超声心动图,获得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)及二尖瓣口舒张早期/晚期血流峰值速度比值(E/A)。采用两独立样本t检验、配对t检验及Pearson相关分析处理数据。结果16头小型猪均建模成功。AMI后Extent、LVEDV、LVESV均较建模前明显增大(t值:-11.14、-4.55、-6.12,均P<0.001),LVEF、E/A明显减小(t值:10.16、2.18,P<0.001,P=0.046)。AMI后LVDD参数PBW、PSD[(142.25±72.06)°、(56.15±26.71)°]均较建模前增大[(33.06±8.98)°、(12.51±5.13)°;t值:-6.11、-6.60,均P<0.001],且与AMI后LVSD参数PBW、PSD[(109.06±62.40)°、(44.40±25.61)°]间存在明显差异(t值:-2.73、-2.20,P值:0.016、0.044)。AMI后LVDD参数PBW、PSD与E/A呈中度负相关(r值:-0.569、-0.566,P值:0.021、0.022),与Extent呈正相关(r值:0.717、0.634,P值:0.002、0.008)。GMPI相位分析评价LVDD具有很好的观察者内及观察者间重复性[组内相关系数(ICC):0.953~0.984,均P<0.001]。结论AMI后1 d即发生LVDD,LVDD可反映舒张功能障碍,左心室灌注缺损范围与LVDD相关。GMPI相位分析是评价LVDD及舒张功能的有效方法。Objective To evaluate the left ventricular diastolic dyssynchrony(LVDD)and its influencing factors early after acute myocardial infarction(AMI)using phase analysis of SPECT gated myocardial perfusion imaging(GMPI).Methods Bama miniature swines(n=16)were subjected to establish AMI models.GMPI was performed before and 1 d after AMI to obtain the extent of myocardial perfusion defect(Extent,%)and left ventricular systolic dyssynchrony(LVSD)/LVDD parameters,namely the phase histogram bandwidth(PBW)and phase standard deviation(PSD).Meanwhile,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),and the ratio of early to late peak mitral diastolic flow(E/A)were obtained by echocardiography.Independent-sample t test,paired t test and Pearson correlation analysis were used to analyze the data.Results Sixteen AMI swines were successfully created.Compared to baseline,Extent,LVEDV and LVESV significantly increased on 1 d after AMI(t values:-11.14,-4.55,-6.12,all P<0.001),while LVEF and E/A significantly decreased(t values:10.16,2.18,P<0.001,P=0.046).GMPI showed that the LVDD parameters PBW and PSD increased significantly on 1 d after AMI when compared to those at baseline((142.25±72.06)°vs(33.06±8.98)°,(56.15±26.71)°vs(12.51±5.13)°;t values:-6.11,-6.60,both P<0.001).There were significant differences between LVSD parameters and LVDD parameters(PBW:(109.06±62.40)°vs(142.25±72.06)°,PSD:(44.40±25.61)°vs(56.15±26.71)°;t values:-2.73,-2.20,P values:0.016,0.044).LVDD parameters PBW,PSD were negatively correlated with E/A after AMI(r values:-0.569,-0.566,P values:0.021,0.022),and positively correlated with the Extent(r values:0.717,0.634,P values:0.002,0.008).The phase analysis of SPECT GMPI to evaluate LVDD showed good intra-observer and inter-observe reproducibility(intraclass correlation coefficient(ICC):0.953-0.984,all P<0.001).Conclusions LVDD occurs early on 1 d after AMI,and can reflect left ventricular diastolic dysfunction.The Exte

关 键 词：心肌梗死 心肌灌注显像 体层摄影术 发射型计算机 单光子 99M锝甲氧基异丁基异腈 猪 

分 类 号：R542.22[医药卫生—心血管疾病]