门控心肌灌注显像在老年左心力衰竭患者中的应用价值

摘要

[Abstwact] Objective To investigate the clinical application of gated myocardial perfusion imaging combined with ultrasonic cardiography in elderly patients with left-sided heart failure and normal left ventricular ej ection fraction (LVEF ),thereby providing an important basis for the management of clinical heart failure. Methods Hospitalized patients with left-sided heart failure were divided into two groups,one with normal LVEF(n= 46 )and the other with reduced LVEF(n=60). Of the 106 patients,39 were male and 67 female,aged between 60 and 85 years,with an average age of 69. 8±16. 8. Gated myocardial perfusion imaging was performed for patients in both groups, recording stress/rest left ventricular end-systolic volume and end-diastolic volume in duplicate,andχ2 test was conducted to detect differences in ischemic area and ventricular volume between the two groups. Results In the group with normal LVEF,gated myocardial perfusion imaging identified mild ischemia in 11 cases,moderate ischemia in 22 cases and severe ischemia in 13 cases,with the ischemic area at(15. 6±6. 6)%,the standard deviation at -2. 3±1. 1 and LVEF at(56. 8±9. 6)%. In the group with reduced LVEF,mild ischemia was found in 8 cases,moderate ischemia in 27 cases and severe ischemia in 15 cases,with the ischemic area at(22. 0±8. 6)%,the standard deviation at -3. 1±2. 6 and LVEF at 31. 9±6. 5%. Differences in ischemic area,severity of ischemia and LVEF between the groups were statistically significant(all P<0. 01 ),as were differences in stress end-diastolic volume, rest end-diastolic volume,stress end-systolic volume and rest end-systolic volume(all P<0. 01 ),and differences in left ventricular end-diastolic diameter,diastolic interventricular septal thickness,posterior left ventricular wall end-diastolic thickness and left ventricular apical diastolic myocardial thickness(all P<0. 01 ). Conclusions Gated myocardial perfusion imaging is a valuable clinical tool in the diagnosis and assessment of left-sided heart failure in the elderly and may help achieve timely and standardized management for this disorder.%目的：探讨门控核素心肌灌注显像结合心脏彩色超声检查在左心室射血分数（LVEF）正常的老年左心力衰竭患者临床应用，为临床心力衰竭治疗提供依据。方法选取LVEF正常组46例和LVEF下降组60例的左心力衰竭竭住院患者，男39例，女67例，年龄60～85岁，平均（69．8±16．8）岁，行门控心肌灌注显像，分别对两组患者负荷和静息两次左心室收缩末期容积、舒张末期容积进行χ2检验，观察缺血面积与心室容量的差异。结果 LVEF正常组门控心肌灌注显像结果轻度缺血11例，中度缺血22例，严重缺血13例，缺血面积百分比为（15．6±6．6）％，严重程度标准差值平均为－2．3±1．1，LVEF值为（56．8±9．6）％；LVEF下降组结果轻度缺血18例，中度缺血27例，严重缺血15例，缺血面积百分比为（22．0±8．6）％，严重程度标准差值平均为－3．1±2．6，LVEF 值为（31．9±6．5）％，两组缺血面积、严重程度和LVEF值比较，差异有统计学意义（均P＜0．01）；两组的负荷舒张末期容积、静息舒张末期容积、负荷收缩末期容积、静息收缩末期容积差异有统计学意义（均P＜0．01）；心脏彩超示左心室舒张期内径、室间隔舒张期厚度、左心室后壁舒张期厚度、左心室心尖舒张期厚度心肌厚度间差异亦有统计学意义（均P＜0．01）。结论门控核素心肌灌注显像为老年性左心力衰竭病因诊断和评估，从而做出及时正确的规范化治疗决策有着重要的临床意义。