肥厚型心肌病合并陈旧性心肌梗死患者的心肌灌注显像

摘要

目的 探讨肥厚型心肌病(HCM)合并陈旧心肌梗死核素MPI的特点,比较合并与未合并冠心病的HCM患者MPI差异.方法 回顾性分析2006年10月至2014年10月间在阜外医院住院的34例HCM合并心肌梗死的患者[其中男26例,女8例,年龄40～80(57±11)岁]99Tcm-MIBISPECT静息MPI资料.按冠状动脉造影或螺旋CT结果确定患者是否合并冠心病(1支或1支以上血管狭窄≥50％为阳性),将患者分为HCM合并冠心病组(组1)和不合并冠心病组(组2).采用17节段半定量评分法计算左心室心肌各节段评分,采用两独立样本t检验对2组患者的评分进行比较.结果 34例HCM中,MPI示节段性放射性浓聚24例,有心肌梗死表现(节段性放射性稀疏至缺损)28例.半定量评分结果:组1(20例)与组2(14例)前壁近心尖段[(0.60±1.27)与(1.57±1.45),t=2.067]、前壁中段(0.20±0.52与0.86±1.29,t=2.056)、侧壁近心尖段(0.30±0.98与1.21±1.48,t=2.175),评分差异有统计学意义(均P＜0.05),其余14个节段评分差异无统计学意义(t值:-1.849～2.175,均P＞0.05).结论 HCM患者即使不存在有意义的冠状动脉狭窄,当发生心肌梗死时,其心肌受损的范围、程度也均较严重.%Objective To investigate 99Tcm-MIBI SPECT MPI characteristics in patients with hypertrophic cardiomyopathy (HCM) complicated with old myocardial infarction (OMI),and to compare the differences of MPI between HCM patients with or without coronary artery disease (CAD).Methods From October 2006 to October 2014,34 patients with HCM complicated with OMI (26 males and 8 females;mean age:(57±11) years) underwent rest 99Tcm-MIBI SPECT MPI in Fu Wai Hospital.The MPI data were retrospectively analyzed.Patients with one or more coronary vessels stenosis ≥ 50％ found by coronary angiography or spiral CT,were considered CAD-positive.Patients were divided into two groups:group 1 including 20 HCM patients with CAD,group 2 including 14 HCM patients without CAD.Semi-quantitative perfusion evaluation was performed in 17 segments,and the scores were compared between two groups using twosample t test.Results In 34 HCM patients,there were 24 patients showed segmental increased uptake on MPI,and 28 patients showed decreased uptake or defect on MPI,which demonstrating the existence of myocardial infarction (MI).Only apical anterior (0.60±1.27 vs 1.57±1.45,t=2.067),mid anterior (0.20±0.52vs 0.86± 1.29,t =2.056) and apical lateral segments (0.30±0.98 vs 1.21 ± 1.48,t =2.175) exhibited significant differences between group 1 and group 2(all P＜0.05).Other 14 segments exhibited no significant differences(t:1.849-2.175,all P＞0.05).Conclusion When MI occurred,a serious myocardial damage both in range and extent could be found in HCM patients even without significant coronary artery stenosis.