双核素心肌显像检查对急性心肌梗死患者延迟经皮冠状动脉介入治疗的指导价值

摘要

目的 分析99Tcm-MIBI /18F-FDG单光子发射计算机化断层显像(single photon emission computed tomography,SPECT)双核素检查对急性心肌梗死患者延迟经皮冠状动脉介入治疗的指导价值.方法 选取急性心肌梗死(acute myocardial infarction,AMI)患者49例,冠脉造影后分为A组(行PCI术,25例)与B组(行药物保守治疗,24例).术前行双核素检查,根据梗死区有无存活心肌分为有存活心肌组(31例)与无存活心肌组(18例).术前、术后1个月、术后3个月行静息心脏超声心动图.结果 ①无存活心肌组:术后1、3个月LVEF值较术前均无改善(P>0.05).②有存活心肌组:行PCI术者术后3个月LVEF值较术前有明显改善,且优于行药物保守治疗者(P<0.05).行药物治疗者术后1、3个月LVEF值较术前无改善(P>0.05).结论 双核素评价AMI患者存活心肌,能预测延迟PCI治疗后室壁功能改善情况,为治疗决策选择提供依据.%Objective To analyze the guidance value of dual-radionuclide myocardial perfusion imaging image by using 99Tcm-methoxyisobutylisonitrile(MIBI)/18F-fluoro-deoxyglucose(FDG) single photon emission computed tomography(SPECT) on delayed percutaneous coronary intervention in patients with acute myocardial infarction.Methods Forty-nine consecutive patients with acute myocardial infarction undergoing cornory artery angiography (CAG) was divided into group A(PCI surgey) (n=25) and group B(drug therapy) (n=24).Myocardial viability was assessed by 99Tcm-MIBI/18F-FDG Myocardial SPECT inpre-procedue.There were 31 patients with viable myocardium segement and 18 patients with nonviable myocardium segement in infracted area.Cardiac events and resting heart echocardiography were assessed pre-procedure, the first and third month post-procedure respectively in all patients.Results ①During the following-up in the first or third month, LVEF were unchanged in nonviable myocardium group undergoing not only PCI but also medicine treatment(P>0.05).②In the third month post-procedure, LVEF in viable myocardium group undergoing PCI (59.61±11.59)% increased significantly compared with pre-proceduer (51.00±11.50)% and medicine treatment (50.62±11.77)% (P<0.05).However, LVEF in viable myocardium group undergoing medicine treatment was unchanged in the first and third month post-procedure(P>0.05).Conclusion Myocardial viability is assessed by hybrid 99Tcm-MIBI SPECT/18F-FDG SPECT in patients with AMI after delayed PCI, which can predict ventricular function recovery and is helpful to decision making in the treatment strategy.