核素心肌显像预测高龄患者围术期心脏事件的价值

摘要

Objective To investigate the predictive value of myocardial perfusion imaging (MPI) on perioperative cardiac events in elderly patients.Methods Thirty-five elderly patients (＞60 years of age) scheduled for major or moderate non-cardiac surgery were subjected to exercise loading/static MPI,adenosine loading/static MPI and resting MPI a week preoperatively,based on their disease severity and physical conditions.This entailed analysis on the left ventricular ejection fraction (LVEF),movement of the cardiac wall and cardiac reserve.The cardiac events,including myocardial infarction,cardiac dysfunction,unstable angina and cardiogenic death,were recorded during the surgery and postoperatively.The predictive value of MPI was determined based on the perioperative cardiac events as evidenced by the images.Results Of 35 patients who underwent MPI,22 had a normal finding.These patients yielded the LVEF,end-systolic volume (ESV) and end-diastolic volume (EDV) of (78±11)％,(39±18)ml and (93±30)ml,respectively.In 13 patients with abnormal MPI imaging,significantly lower LVEF (51±14)％ yet markedly higher ESV (62±34)ml and EDV (127±42)ml were noted (all P＜0.05).Six patients had a low LVEF and 8 aberrant movement of the cardiac wall.Three cardiac events were recorded in patients with abnormal MPI,whilst nil cardiac events were captured in those with normal MPI.Conclusion MPI effectively predicts the incidence of postoperative cardiac events and may clinically tailor disease prevention,decision-making of treatment and prediction of prognosis.%目的 探讨核素心肌灌注显像(MPI)预测高龄患者围手术期心脏事件的临床应用价值.方法 35例拟行大中型非心脏手术,年龄＞60岁患者于术前1周内根据病情及身体状况行运动负荷-静息心肌显像,腺苷负荷-静息心肌显像及单纯静息心肌显像,分析影像所见,左室射血分数(LVEF)及室壁运动,对患者的心脏贮备功能做出判断.记录患者术中及术后发生的心脏事件,包括心肌梗死、心功能不全、不稳定性心绞痛及心源性死亡.分析心肌显像结果对心脏事件的预测价值.结果 ①35例患者中MPI结果正常22例LVEF、收缩末期容积(ESV)及舒张末期容积EDV分别为(78±11)％,(39±18)ml和(93±30)ml;心肌显像结果异常13例,LVEF为(51±14)％,明显低于心肌显像正常组(P＜0.05)；ESV及EDV分别为(62±34)ml和(127±42)ml,明显高于心肌显像正常组(P＜0.05).LVEF≤50％者6例,室壁运动异常8例.②心肌显像结果异常的患者中3例在术后发生了心脏事件；心肌显像结果正常的患者无一例发生心脏事件.结论 MPI能有效地预测围手术期心脏事件的发生,对临床预防、治疗决策以及预后判断都具有非常重要的临床指导意义.