心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值

doi:10.3969/j.issn.1006-7795.2021.01.005

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (1): 26-30.doi: 10.3969/j.issn.1006-7795.2021.01.005

心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值

谷珊珊^1,2, 卢洁^1,3,4*, 陈刚²

1.首都医科大学宣武医院核医学科,北京 100053;
2.民航总医院核医学科, 北京 100123;
3.首都医科大学宣武医院放射科, 北京 100053;
4.磁共振成像脑信息学北京市重点实验室, 北京 100053

收稿日期:2020-11-30 出版日期:2021-02-21 发布日期:2021-02-02
基金资助:
北京市医院管理局“登峰”计划专项经费资助(DFL 20180802)。

Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease

Gu Shanshan^1,2, Lu Jie^1,3,4*, Chen Gang²

1. Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
2.Department of Nuclear Medicine, Civil Aviation General Hospital, Beijing 100123, China;
3.Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
4. Beijing Key Lab of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, China

Received:2020-11-30 Online:2021-02-21 Published:2021-02-02
Contact: ^*E-mail:imaginglu@hotmail.com
Supported by:
Beijing Municipal Administration of Hospitals' Ascent Plan(DFL 20180802).

摘要/Abstract

摘要： 目的探讨核素心肌灌注显像(myocardial perfusion imaging, MPI)半定量分析不同缺血程度对老年冠状动脉粥样硬化性心脏病(coronary artery disease, CAD,以下简称冠心病)的诊断价值。方法以2017年8月至2020年6月于民航总医院行两日法静息-负荷心肌灌注显像的99例患者为研究对象,所有患者均于6个月内行冠状动脉造影(coronary angiography, CAG),根据CAG结果分为冠心病组52例(病例组)和非冠心病组47例(对照组)。收集患者的一般临床资料、MPI静息总评分(summed rest score, SRS)、负荷总评分(summed stress score, SSS)、静息-负荷差值评分(summed difference score, SDS)及CAG结果进行分析。组间均数比较采用t检验,率比较采用χ²检验,多因素分析采用多因素Logistic回归分析。结果 99例患者平均年龄为(67.24±5.18)岁,其中男性53例,女性46例。SSS及SDS均为冠心病的独立危险因素,OR值分别为(7.425, 95%CI: 2.873~19.192, P＜0.001) 及(8.020, 95%CI: 2.980~21.984, P＜0.001)。心肌血流灌注异常(SSS＞3)诊断CAD的一致性,优于心肌血流灌注异常与心肌不同缺血情况的联合实验。结论 MPI半定量分析SSS及SDS是老年冠心病的独立危险因素,但SSS联合SDS不同缺血情况不能提高老年冠心病的诊断效能。

关键词: 冠状动脉粥样硬化性心脏病, 心肌灌注显像, 心肌缺血

Abstract: Objective To evaluate the value of different thresholds of myocardial perfusion and ischemia scores obtained from myocardial perfusion imaging (MPI) in diagnosing in elderly persons with suspected coronary artery disease. Methods A total of 99 patients [mean age (67.24±5.18) years, 53 male and 46 female] who underwent two-day rest-stress MPI in Department of Nuclear Medicine, Civil Aviation General Hospital from August 2017 to June 2020 were enrolled, and the data were analyzed retrospectively. According to coronary angiography (CAG) results, the patients undergoing CAG within 6 months were divided into coronary artery disease (CAD) group(patients group, 52 cases) and non-CAD group (control group, 47 cases). The general clinical information, summed rest score (SRS), summed stress score (SSS) and summed difference score (SDS) were collected. t test and χ² test were used to compare the data between the different groups. Multivariate Logistic regressions were used to establish the independent diagnostic value and accuracy of MPI parameters. Results In multivariate analysis accounting for clinical variables associated with CAD, both SSS (7.425, 95%CI: 2.873-19.192, P＜0.001) and SDS (8.020, 95%CI: 2.980-21.984, P＜0.001) were independently related with CAD. The consistency of SSS＞3 in the diagnosis of CAD is better than the different threshold of myocardial perfusion combined with ischemia. Conclusion The myocardial perfusion and ischemia scores from MPI are independent risk factors for predicting CAD in the elderly persons, but SSS combined with different SDS thresholds could not improve the diagnostic efficiency of elderly persons with suspected coronary disease.

Key words: coronary artery disease, myocardial perfusion imaging, myocardial ischemia

中图分类号:

谷珊珊, 卢洁, 陈刚. 心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值[J]. 首都医科大学学报, 2021, 42(1): 26-30.

Gu Shanshan, Lu Jie, Chen Gang. Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease[J]. Journal of Capital Medical University, 2021, 42(1): 26-30.

参考文献

[1] 中华医学会老年医学分会,高龄老年冠心病诊治中国专家共识写作组.高龄老年冠心病诊治中国专家共识[J].中华老年医学杂志,2016,35(7): 683-691.
[2] Nakanishi R, Gransar H, Slomka P, et al. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging[J]. J Nucl Cardiol,2016,23(3):530-541.
[3] Henzlova M J, Duvall W L, Einstein A J, et al. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers[J]. J Nucl Cardiol, 2016, 23(3): 606-639.
[4] Dorbala S, Ananthasubramaniam K, Armstrong L S,et al. Sinale photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpre-tation[J].J Nucl Cardiol,2018,25(5):1784-1846.
[5] Malhotra S, Sharma R, Kliner D E, et al .Relationship between silent myocardial ischemia and coronary artery disease risk factors[J]. J Nucl Cardiol, 2013,20(5):731-738.
[6] Bamberg F, Mayrhofer T, Ferencik M, et al. Age-and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography: pooled evidence from ROMICA T II and ACRIN-PA trials[J]. Eur Radiol,2018,28(2):851-860.
[7] 中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会动脉粥样硬化与冠心病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会,等. 稳定性冠心病诊断与治疗指南[J].中华心血管病杂志,2018,46(9):680-694.
[8] Alzahrani A, Ruddy T D.Stress myocardial perfusion imaging in the elderly[J].J Nucl Cardiol,2018,25(1): 72-74.
[9] De Winter O, Van de Veire N, Gemmel F, et al.Myocardial perfusion imaging in the elderly: a review[J]. Nucl Med Commun,2006,27(6):529-534.
[10]Doukky R, Hayes K, Frogge N, et al. Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging[J]. Circulation, 2013,128(15):1634-1643.
[11]罗诗雨,姚志明,陈聪霞,等.门控心肌灌注显像相位分析预测冠心病主要心脏不良事件的价值[J].中华核医学与分子影像杂志,2020,40(3):136-141.
[12]Canepa M,Bezante G,Vianello P,et al. Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease[J].J Cardiovasc Med,2016,17(10):719-728.
[13]Task Force Members, Montalescot G, Sechtem U, et al.2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J,2013,34(38):2949-3003.
[14]Fihn S D, Gardin J M, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American Collegeof Cardiology Foundation /American Heart Association task force on practice guidelines,and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons[J]. J Am Coll Cardiol,2012,60(24):e44-164.

[1]	陈璐, 郭新颖, 刘建, 杜凤和, 郭彩霞. 冠状动脉粥样硬化性心脏病患者可溶性高级糖基化终末产物受体与肾功能的相关性分析[J]. 首都医科大学学报, 2022, 43(2): 167-172.
[2]	夏宁, 聂秀红, 王昊, 樊晓君. 支气管哮喘合并OSA与冠心病发病率的相关性研究[J]. 首都医科大学学报, 2022, 43(1): 138-142.
[3]	刘瑾春, 郑秀花, 李宁, 张瑞霞, 张海柱. 不稳定型心绞痛患者冠状动脉侧支循环形成的预测因素研究[J]. 首都医科大学学报, 2021, 42(4): 642-646.
[4]	胡宾, 周玉杰, 贾德安, 秦政, 许晓晗, 杨士伟, 周志明. 冠状动脉斑块旋磨联合药物洗脱支架术对不同年龄段老年钙化治疗效果的对比分析[J]. 首都医科大学学报, 2021, 42(1): 101-104.
[5]	李响, 蒲连美, 阮杨, 李红, 金泽宁. 汉族人群ADIPOR1 rs7539542与冠状动脉粥样硬化性心脏病和2型糖尿病的关联分析[J]. 首都医科大学学报, 2020, 41(6): 935-942.
[6]	许晓晗, 程宇婧, 刘晓丽, 周玉杰. 守护生命的“心”路——周玉杰教授[J]. 首都医科大学学报, 2020, 41(5): 844-848.
[7]	李扬, 董然, 芮宏亮, 刘韬帅, 郑居兵, 徐晓宇, 赵洋, 宋邦荣, 张魁. 合并慢性肾功能不全的冠状动脉粥样硬化性心脏病患者冠状动脉搭桥手术的预后及其影响因素[J]. 首都医科大学学报, 2020, 41(4): 597-602.
[8]	魏嘉洁, 矫杰, 周迎生. 2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特征及其危险因素[J]. 首都医科大学学报, 2020, 41(1): 35-39.
[9]	熊筱伟, 郭彩霞, 徐晓薇, 穆利英, 胡宏宇, 陈威, 陈步星. 血浆氧化三甲胺及其前体物质浓度与冠状动脉粥样硬化性心脏病的关系[J]. 首都医科大学学报, 2020, 41(1): 99-102.
[10]	夏勇, 张建卿, 王少霞, 陈丹, 姬建民. 沙库巴曲缬沙坦联合琥珀酸美托洛尔缓释片治疗冠状动脉粥样硬化性心脏病并慢性心力衰竭的效果观察[J]. 首都医科大学学报, 2020, 41(1): 113-118.
[11]	李靖, 高敬. 二尖瓣环自动追踪技术评价冠状动脉粥样硬化性心脏病病人左心室收缩功能[J]. 首都医科大学学报, 2017, 38(3): 386-390.
[12]	郭彩霞, 江雪, 曾翔俊, 陈步星. STAT3在sRAGE抑制缺血再灌注导致的心肌细胞凋亡中的作用[J]. 首都医科大学学报, 2016, 37(1): 41-47.
[13]	王德昭, 马宁, 胡宏宇, 莫大鹏, 付强, 陈威, 姜桂莹, 缪中荣, 陈步星. 冠状动脉病变与弓上动脉颅内外段病变相关性探讨[J]. 首都医科大学学报, 2016, 37(1): 58-61.
[14]	杨耀国, 陈忠, 唐小斌, 寇镭, 吴章敏, 刘晖, 王盛, 张征, 贾云峰, 何楠. 腹主动脉瘤合并冠心病的临床特点及围术期处理[J]. 首都医科大学学报, 2015, 36(1): 23-27.
[15]	谷珊珊, 王蒨, 董薇, 焦建, 苏航, 付瑛. 心脏融合显像定量评价功能相关冠状动脉狭窄的临床研究[J]. 首都医科大学学报, 2013, 34(1): 36-42.

心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值

Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价