脾关闭征--ATP负荷心脏磁共振灌注成像中评估心肌负荷成功的指标  

Splenic Switch-Off:A Tool to Assess Stress Adequacy in ATP Perfusion Cardiac MR Imaging

作　　者：孔慧慧 曹佳鑫 田晋帆 雍婧雯 宋现涛[2] 贺毅 KONG Huihui;CAO Jiaxin;TIAN Jinfan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,P.R.China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050 [2]首都医科大学附属北京安贞医院心内科

出　　处：《临床放射学杂志》2022年第5期838-841,共4页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目(编号:81971569)。

摘　　要：目的心脏磁共振心肌负荷灌注成像(S-CMR)对心肌负荷成功评估仍然是一项临床挑战,因为缺乏一种无创的临床标志物作为金标准。本研究旨在验证脾关闭征(SSO)评估充血反应,并将其与当前临床指标进行比较。方法选取于本院行S-CMR的患者79例。所有患者因胸痛等症状入院,通过冠状动脉CT血管造影(CCTA)证实无明显冠状动脉狭窄(心外膜动脉狭窄程度<50%)。所有患者均签署知情同意书。男54例,女25例,平均年龄(55.28±10.113)岁。排除了不稳定性心绞痛、重度心率失常、房颤等心脏病史及三磷酸腺苷(ATP)、钆喷酸葡胺(Gd-DTPA)过敏患者以及MRI禁忌证者。结果79例患者中4例排除(2例没扫到脾脏,2例未注射对比剂)。75例可进行SSO评判且观察者之间对SSO的视觉评价具有很好的一致性。将临床最常用充血反应的生理指标心率上升>15次/min、血压下降>10 mmHg以及出现负荷药物不良反应(胸闷等)与之对比。经视觉分析,使用ATP心肌负荷时,95%(71/75)均出现SSO,95%(75/79)出现心率升高等生理指标的改变。经McNemar’s检验两组指标在诊断心肌负荷成功方面无统计学差异(P>0.05);并且经Kendall’s tau-b检验显示SSO与其他因素(性别、吸烟、高血压、糖尿病、血脂异常等)无相关性(P=0.161、0.713、0.182、0.097、0.466)。结论SSO可作为一种新的简单的方式来判断ATP作为负荷药物时心肌是否负荷成功;并且与其他因素(如高血压、吸烟以及血脂异常等)无关,显示出良好的稳定性。Objective Assessment of hyperaemia during adenosine triphosphate(ATP)stressed perfusion cardiovascular magnetic resonance(S-CMR)remains a clinical challenge with lack of a noninvasive clinical marker as a gold standard to confirm hyperaemic response.The aim of this study is to validate Splenic switch off(SSO)for assessment of hyperaemic response and compare it with current clinical markers of ATP stress.Methods All patients were admitted to hospital with chest pain and confirmed no significant coronary artery stenosis(epicardial artery stenosis<50%)by coronary angiography(Coronary Computed Tomography Angiography,CCTA).All patients have signed their informed consent forms.Among them,54 are(68%)males,25 are(32%)females,with an age of(55.28±10.113)years.Patients with history of heart disease such as unstable angina,severe arrhythmia,atrial fibrillation were excluded and patients with ATP,Gd DTPA allergy and contraindications to MRI were excluded.Results Four of the 79 patients were excluded,with two without scanning the spleen and two without contrast injection.The spleen was visible in 95%(75/79)of examinations and the agreement among observers in the visual grading of SSO was excellent.This study was to compare SSO with other physiological markers of hyperaemia(The heart rate increase>15 beats per minute,the blood pressure decrease>10 mm Hg,or the adverse stress drug reactions,chest tightness etc.).Visually,SSO occurred in 95%of ATP studies and 95%also changed in physiological indicators(increase of heart rate).There was no statistical difference between the two groups of McNemar’s test in the assessment of hyperaemia(P>0.05).Kendall’s tau-b test showed no correlation between SSO and other factors(sex,smoking,hypertension,diabetes,dyslipidemia,etc.)(P=0.161、0.713、0.182、0.097、0.466,respectively).Conclusion SSO can be used as a new,simple observation to judge whether the myocardium was successfully stressed with ATP.SSO is unrelated to other factors(such as hypertension,smoking,hyperlipemia etc.),showin

关 键 词：心脏磁共振成像 心肌负荷灌注技术 三磷酸腺苷 脾关闭征 

分 类 号：R445.2[医药卫生—影像医学与核医学] R551.1[医药卫生—诊断学]