经皮冠状动脉介入开通慢性完全闭塞病变对左室心肌灌注和收缩同步性的影响  

Impact on myocardial perfusion and left ventricular systolic synchronization after percutaneous coronary intervention of chronic total occlusion

作　　者：郑耐心[1] 李旭[2] 艾虎[1] 李辉[1] 赵迎 唐国栋[1] 杨国建[1] 孙福成[1] 姚稚明[2] 张慧平[1] Zheng Naixin;Li Xu;Ai Hu;Li Hui;Zhao Ying;Tang Guodong;Yang Guojian;Sun Fucheng;Yao Zhiming;Zhang Huiping(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科国家老年医学中心中国医学科学院老年医学研究院,100730 [2]北京医院核医学科,100730

出　　处：《中国心血管杂志》2022年第3期229-234,共6页Chinese Journal of Cardiovascular Medicine

基　　金：2017年首都临床特色应用研究与成果推广项目(Z171100001017202);北京医院临床研究121工程(BJ-2018-201)。

摘　　要：目的分析经皮冠状动脉介入(PCI)开通慢性完全闭塞(CTO)病变对左室心肌灌注和收缩同步性的影响。方法登记2017年1月至2019年12月在北京医院对CTO病变行PCI治疗的312例患者,其中36例于CTO病变开通前及开通12个月后均进行了门控心肌灌注显像(G-MPI)检查纳入本研究。采用配对或独立样本t检验及Wilcoxon秩和检验的方法比较PCI开通CTO病变前后负荷总积分(SSS)、静息总积分(SRS)、差值总积分(SDS)、灌注可逆性节段数(RS)、灌注不可逆节段数(NRS)、心肌总灌注缺损范围(TPD)、左心室射血分数(LVEF)以及静息和负荷的相位直方图带宽(PBW)和相位标准差(PSD)等指标,用Pearson线性相关分析LVEF与PBW和PSD的关系。结果36例患者CTO病变开通后,SSS(7.2±7.9比10.8±6.9,t=3.612,P=0.001)、SRS(4.4±6.3比5.9±5.9,t=2.721,P=0.010)和SDS(2.8±3.1比4.7±4.0,t=2.727,P=0.010)均较开通前显著降低,RS(1.9±1.9比3.5±2.1,t=3.843,P=0.001)和负荷TPD(10.0%±11.1%比14.7%±10.0%,t=3.838,P=0.001)也较开通前明显减少。在心肌收缩同步性参数中,负荷PBW[(66.7±26.8)°比(83.1±33.0)°,t=3.365,P=0.002]和PSD[(18.3±6.9)°比(22.8±9.7)°,t=2.972,P=0.005]较开通前显著降低。无论是CTO病变开通前还是开通后,LVEF与静息或负荷状态下的PBW和PSD均呈显著负相关,并且LVEF≥50%患者的静息PBW、PSD和负荷PBW、PSD均显著低于LVEF<50%者(均为P<0.05)。结论CTO病变经PCI开通后心肌可逆性缺血和负荷状态下的心肌收缩同步性可得到改善,LVEF与心肌收缩同步性指标呈负相关,高LVEF的CTO患者的心肌收缩同步性更好。Objective To evaluate the impact on myocardial perfusion and left ventricular systolic synchronization after percutaneous coronary intervention(PCI)of chronic total occlusion(CTO).Methods The 312 consecutive CTO patients underwent PCI were enrolled in Beijing Hospital from January 2017 to December 2019.CTO patients who received gated myocardial perfusion imaging(G-MPI)before PCI procedure and 12 months after the opening of the CTO lesions were obtained.Paired and independent samples t test or Wilcoxon rank sum test were used to compare summed stress score(SSS),summed rest score(SRS),summed different score(SDS),number of reversible segments(RS),number of nonreversible segments(NRS),total perfusion defect(TPD),left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV),phase histogram bandwidth(PBW)and phase standard deviation(PSD)at rest and stress.Pearson linear correlation was used to analyze the relationship between LVEF and left ventricular systolic synchronization parameters.Results A total of 36 patients who opened the CTO lesions were finally enrolled.SSS(7.2±7.9 vs.10.8±6.9,t=3.612,P=0.001),SRS(4.4±6.3 vs.5.9±5.9,t=2.721,P=0.010),SDS(2.8±3.1 vs.4.7±4.0,t=2.727,P=0.010)and RS(1.9±1.9 vs.3.5±2.1,t=3.843,P=0.001),as well as TPD(10.0%±11.1%vs.14.7%±10.0%,t=3.838,P=0.001)at stress reduced significantly compared with those before procedure.In systolic synchronization parameters,PBW[(66.7±26.8)°vs.(83.1±33.0)°,t=3.365,P=0.002]and PSD[(18.3±6.9)°vs.(22.8±9.7)°,t=2.972,P=0.005]at stress significantly decreased after procedure.The correlation analysis revealed LVEF was negatively correlated with PBW and PSD both at rest and at stress condition before and after recanalization of the CTOs.Both PBW and PSD at rest and at stress in patients with LVEF≥50%were significantly lower than those of patients with LVEF<50%(all P<0.05).Conclusions The reversible myocardial ischemia and systolic synchronization parameters at stress could be improved after the opening of CTOs.LVEF is ne

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 体层摄影术 发射型计算机 单光子 心肌灌注 心肌收缩 

分 类 号：R541.4[医药卫生—心血管疾病]