门控心肌灌注显像评价肥厚型心肌病心肌缺血的临床价值

摘要

目的 探讨门控心肌灌注显像评价肥厚型心肌病患者心肌缺血情况的临床应用价值.方法 选取核素心肌灌注显像均为阳性的69例临床确诊的肥厚型心肌病住院患者,分为冠状动脉造影阳性(管腔狭窄≥50%)和阴性(管腔狭窄＜50%)2组,对比其心肌缺血的门控心肌灌注显像特点,并进行两样本t检验.结果 冠状动脉造影阳性组19例,其中9例表现为可逆性心肌缺血,10例表现为不可逆性心肌缺血;8例射血分数(EF)升高,为(69.1±2.8)%,11例下降,为(42.8±2.1)%.冠状动脉造影阴性组50例,其中37例表现为可逆性心肌缺血,13例表现为不可逆性心肌缺血;38例EF值升高,为(70.8±4.0)%,12例下降,为(48.9±2.7)%.2组缺血范围[(29.7±17.8)%与(24.1±16.0)%]、缺血严重程度和EF值组间差异均有统计学意义(t=9.28,16.51和2.65,P＜0.001,＜0.001和＜0.01).结论 门控心肌灌注显像发现肥厚型心肌病合并冠心病患者心肌缺血情况要严重于无合并冠心病患者;冠心病对于改变肥厚型心肌病的病理生理过程、自然病程和预后可能起重要作用.%Objective To evaluate the value of gated ~(99)Tc~m-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in detection of myocardial ischemia in hypertrophic cardiomyopathy.Methods Sixty-nine patients with clinically proven hypertrophic cardiomyopathy were divided into 2 groups using coronary angiogram as "gold standard":positive group(n=19,narrowing≥50%) and negative group (n=50,narrowing＜50%).Gated ~(99)Tc~m-MIBI myocardial perfusion imaging was performed and positive in all 69 patients (41 males,28 females,aged 35-75 years).Comparative analysis between the two groups was carried out using t-test.Results In the positive group,reversible and irreversible perfusion defects were detected in 9 and 10 patients,respectively.Left ventricular ejection fraction (LVEF) increased to (69.1±2.8)% in 8 patients and decreased to(42.8±2.1)% in 11 patients.In the negative group,reversible and irreversible perfusion defects were found in 37 and 13 patients,respectively.LVEF increased to(70.8±4.0)% in 38 patients and decreased to(48.9±2.7)% in 12 patients.The values of ischemic area,severity and extent of perfusion defect,and LVEF were significantly different between the two groups(t=9.28,16.51,2.65;P＜0.001,＜0.001,＜0.01,respectively).Conclusions Gated ~(99)Tc~m-MIBI myocardial perfusion imaging is valuable in assessing patients with hypertrophic cardiomyopathy.Detection for the presence or absence of coexisting coronary artery disease and myocardial ischemia has an important prognostic indication and management indication for these patients.