核素心肌灌注显像在特发性室性早搏患者中的应用  

Application of radionuclide myocardial perfusion imaging in patients with idiopathic premature ventri-cular contractions

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作  者:范晓娟 刘平[1] 白玲[1] Fan Xiaojuan;Liu Ping;Bai Ling(Department of Cardiology,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区:[1]西安交通大学第一附属医院心内科,西安710061

出  处:《中华心律失常学杂志》2022年第5期455-460,共6页Chinese Journal of Cardiac Arrhythmias

摘  要:目的探索特发性室性早搏(室早)患者的静息核素心肌灌注显像(MPI)的异常及其应用价值。方法回顾性纳入2013年1月至2020年12月在西安交通大学第一附属医院心内科就诊的无器质性心脏病流出道室早患者,研究其体表心电图、24 h动态心电图、超声心动图、MPI资料,分析室早负荷、起源部位、联律间期、性别、左心室射血分数(LVEF)等指标与MPI心肌代谢减低程度的关系。结果入选125例患者,其中男41例,年龄48(37,54)岁,室早负荷14.1%(7.1%,21.9%),LVEF为66%(62%,70%)。47例患者表现为正常MPI(正常组),其余78例(62.4%,78/125)根据MPI代谢减低程度分为单心室壁代谢减低组(35例)、至少两心室壁代谢减低组(32例)和广泛左心室壁代谢减低组(11例)。Spearman相关分析示特发性室早患者的MPI心肌代谢减低程度与室早负荷呈正相关(r=0.290,P=0.001),与LVEF呈负相关(r=-0.271,P=0.003)。多元有序Logistic回归结果示,室早负荷是心肌代谢减低的独立影响因素(OR=1.061,95%CI 1.026~1.097,P<0.001),男性风险高于女性(OR=8.387,95%CI 3.819~18.419,P<0.001),右心室流出道来源的室早导致心肌代谢减低的风险高于左心室流出道(OR=2.256,95%CI 1.062~4.792,P=0.034)。结论特发性室早患者的核素心肌代谢异常早于LVEF减低,其程度与室早负荷呈正相关,与LVEF呈负相关。室早负荷、男性、右心室流出道来源是特发性室早患者核素心肌代谢减低的独立影响因素。Objective To explore the manifestations and application value of resting nuclide myocardial perfusion imaging(MPI)in patients with idiopathic premature ventricular contractions(PVC).Methods We retrospectively enrolled 125 patients with idiopathic PVC originating from ventricular outflow tract at Department of Cardiology The First Affiliated Hospital of Xi′an Jiaotong University from January 2013 to December 2020.All of them were ruled out organic heart disease including coronary artery stenosis.The surface electrocardiogram,24 hour Holter monitoring,echocardiology and MPI were used to analyze the correlations between PVC characteristics(including PVC burden,origin,couple interval),left ventricular ejection fraction(LVEF)and MPI manifestations.Results Of the 125 patients,41 were male,with a median age of 48(37,54)years.The median value of PVC burden was 14.1%(7.1%,21.9%),and the median LVEF was 66%(62%,70%).Forty-seven patients presented with normal MPI(normal group),and the remaining 78 patients(62.4%,78/125)were divided into three groups according to the degree of MPI impairment,including 35 patients with single wall metabolic impairment,32 patients with at least two-ventricular wall metabolic impairment,and 11 patients with extensive ventricular wall metabolic impairment.Spearman correlation analysis showed that the severity of myocardial metabolic impairment on MPI was positively correlated with PVC burden(r=0.290,P=0.001),and negatively correlated with LVEF(r=-0.271,P=0.003).Multivariate ordinal Logistic regression showed that PVC burden was an independent factor of reduced myocardial metabolism(OR=1.061,95%CI 1.026-1.097,P<0.001),male had a higher risk than female(OR=8.387,95%CI 3.819-18.419,P<0.001),and patients with PVC originating from right ventricular outflow tract had a higher risk of reduced myocardial metabolism than left ventricular outflow tract(OR=2.256,95%CI 1.062-4.792,P=0.034).Conclusion In patients with idiopathic PVC,MPI showed impaired myocardial metabolism before LVEF significantly decrea

关 键 词:室性早搏复合征 心肌灌注显像 心肌代谢 左心室射血分数 心肌病 

分 类 号:R541.7[医药卫生—心血管疾病]

 

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