《中国康复理论与实践》

《中国康复理论与实践》 ›› 2006, Vol. 12 ›› Issue (06): 464-466.

• 专题 • 上一篇    下一篇

运动心肌灌注显像对可疑或确诊冠心病患者预后的判断价值

张守彦1; 王显2; 尤安民3; 杨士伟4; 张健2; 郭实2; 胡大一1,4   

  1. 1.首都医科大学附属同仁医院心脏中心 北京市 100037;2.北京军区总医院心肺血管中心 北京市 100070;3.河南省洛阳市中心医院核医学科 河南洛阳市 471009;4.北京大学人民医院心内科 北京市 100012
  • 收稿日期:2006-01-28 出版日期:2006-06-25 发布日期:2006-06-25

Prognostic Value of 99mTC-MIBI SPECT Exercise Myocardial Imaging in Patients with Suspected or Diagnosed Coronary Artery Disease

ZHANG Shou-yan, WANG Xian, YOU An-min, et al   

  1. Centerof Cardiology, AfflicatedTongren Hospital of Capital University of Medical Sciences, Beijing 100006, China
  • Received:2006-01-28 Published:2006-06-25 Online:2006-06-25

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摘要： 目的探讨运动心肌灌注显像对可疑或确诊冠心病患者预后的判断价值。方法对116例可疑或确诊冠心病患者行运动试验和心肌灌注显像,并进行心脏事件随访。结果得到随访资料106例,平均随访(25±8)个月,共发生心脏事件11例,单因素分析显示,年龄、陈旧性心肌梗死史、运动高峰心率、从静息到运动高峰的心率变化、运动高峰收缩压、从静息到运动高峰的收缩压变化、异常心肌显像、心肌灌注缺损数目和缺血容积率(IVR)的大小是预测心脏事件发生的有价值的危险因素。多因素逐步Lo-gistic回归分析显示,IVR的大小是心脏事件发生的最有价值的预测因子,IVR≥25%时心脏事件发生的危险性明显升高(相对危险度5.9,P<0.005);尤其当心肌灌注显像正常时,IVR<25%发生心脏事件的危险性极低。结论运动心肌灌注显像可作为预测可疑或确诊冠心病患者发生心脏事件的无创性检查方法;根据心肌灌注显像时IVR的大小可有效区分高危和低危患者。

关键词: 心脏, 放射性核显像, 99mTC, 运动试验, 冠状动脉疾病, 预后, 单光子发射型计算机断层

Abstract: ObjectiveTo examine the prognostic value of 99mTC-MIBI single-photon emission computed tomography (SPECT) in patients with suspected or diagnosed coronary artery disease (CAD).Methods116 patients with suspected or diagnosed CAD were examined with 99m TC-MIBI SPECT exercise and rest myocardial imagings, and followed by investigation of cardiac events.Results Follow-up information was complete in 106 patients. Over an average follow-up of 25±8 months, cardiac events occurred in 11 patients. Univariate analyses showed that age, old myocardial infarction, exercise peak heart rate, the change in heart rate from rest to exercise peak, exercise peak systolic blood pressure, the change in systolic blood pressure from rest to exercise peak, abnormal myocardial imaging, the number of myocardial perfusion defect and ischemic volume rate (IVR) were the effective predictors of subsequent cardiac events. Multivariate stepwise Logistic regression analyses revealed that the size of IVR was the only variable with independent predictive value for occurrence of subsequent cardiac events. IVR more than 25% was associated with a significantly increased frequency of subsequent cardiac events (relative risk ratio was 5.9, P<0.005). IVR less than 25% or even normal myocardial perfusion imaging was associated with a very low-risk of cardiac event and a very good prognosis.Conclusion 99mTC-MIBI SPECT myocardial imaging is the most effective noninvasive technique that predicted the occurrence of cardiac event in patients with suspected or diagnosed CAD. According to the size of IVR, high-risk and low-risk patients can be effectively identified.

Key words: heart, radionuclide imaging, 99mTC, exercise test, coronary artery disease, prognosis, single-photon emission computed tomography