核素心肌显像对急性心肌梗死患者 PTCA后左心室收缩功能变化的评估价值

Evaluation value of radionuclide myocardial imaging on left ventricular systolic function changes in patients with acute myocardial infarction after PTCA

    摘要
  • 摘要:
    目的 探讨核素心肌灌注/代谢显像对急性心肌梗死（AMI）患者经皮腔内冠状动脉成形术（PTCA）后左心室收缩功能变化的评估价值。
    方法 回顾性分析2015年6月至2017年12月于山西医科大学附属第一医院行PTCA治疗的AMI患者36例，其中男性27例、女性9例，年龄（57.9±12.3）岁。所有患者均在AMI发病1周内行PTCA治疗，并于治疗前3天和治疗后6~8个月行99Tcm-甲氧基异丁基异腈SPECT心肌灌注显像（MPI）和18F-氟脱氧葡萄糖PET/CT心肌代谢显像。根据治疗后左心室射血分数（LVEF）的变化值（ΔLVEF）将患者分为2组：A组为心功能改善组（ΔLVEF≥5%）；B组为心功能未改善组（ΔLVEF＜5%）。采用t检验和χ2检验分析比较2组患者的临床资料、LVEF、高峰射血率（PER）、存活心肌/坏死心肌节段数（S/N）比值及心肌肌钙蛋白I（cTnI）等指标间的差异；采用Logistic回归分析影响左心室收缩功能的相关因素；采用受试者特征工作（ROC）曲线分析预测LVEF改善（ΔLVEF≥5%）的S/N界值。
    结果 （1）2组患者的性别、年龄、体重指数、吸烟史、高血压病史、糖尿病史、高脂血症病史、心绞痛病史等差异均无统计学意义（均P＞0.05）。（2）PTCA治疗前，A组和B组间LVEF、PER、cTnI的差异无统计学意义，而S/N比值（A组：1.24±1.06，B组：0.58±0.37）的差异有统计学意义（t=0.824，P=0.042）；PTCA治疗后，2组间LVEF（A组：47±12，B组：38±10）、PER（A组：2.11±0.48，B组：1.71±0.50）、S/N比值（A组：0.73±0.47，B组：0.62±0.39）的差异有统计学意义（t=−2.528、−2.366、−2.514，P=0.016、0.024、0.017），但cTnI间的差异无统计学意义。（3）Logistic回归分析显示，S/N比值是ΔLVEF的独立影响因素（OR=2.164，P=0.018）。（4）ROC曲线结果显示，以S/N比值预测AMI患者PTCA治疗后ΔLVEF≥5%的界值为0.62，曲线下面积为0.823（95%CI：0.661~0.985），特异度为85.71%，灵敏度为91.54%。
    结论 核素心肌灌注/代谢显像对AMI患者行PTCA治疗后左心室收缩功能变化的评估具有重要的临床价值。

     

    Abstract:
    Objective To evaluate the value of radionuclide myocardial perfusion/metabolic imaging in the assessment of left ventricular systolic function after percutaneous coronary intervention and percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
    Methods The present study was a retrospective analysis of 36 patients (male/female, 27/9; age, 57.9±12.3 years) with AMI who were treated with PTCA in the First Affiliated Hospital of Shanxi Medical University from June 2015 to December 2017. All patients received PTCA treatment within 1 week of onset of AMI. SPECT myocardial perfusion imaging and PET/CT myocardial metabolic imaging were performed 3 days before and 6–8 months after treatment. Patients were then divided into two groups, namely, group A (left ventricular ejection fraction (LVEF) change value (ΔLVEF), ΔLVEF≥5%) and group B (ΔLVEF<5%). The t- and χ2 tests were used to compare differences between the two groups in terms of clinical data (LVEF, peak ejection rate (PER), ratio of surviving myocardium/necrotic myocardium (S/N) and cardiac troponini (cTnI) Logistic regression was used to analyze the factors affecting left ventricular systolic function. Receiver operating characteristic (ROC) curve analysis determined the S/N ratio cutoff for improved LVEF values (ΔLVEF≥5%).
    Results No statistically significant differences in gender, age, body mass index, history of smoking, hypertension, diabetes, hyperlipidemia, and angina were found between the two groups (all P>0.05). Before PTCA treatment, differences in LVEF, PER, and troponin cTnI between groups A and B were not statistically significant but differences in S/N ratio (group A: 1.24±1.06, group B: 0.58±0.37) were statistically significant (t=0.824, P=0.042). After PTCA treatment, differences in LVEF (group A: 47±12, group B: 38±10), PER (group A: 2.11±0.48, group B: 1.71±0.50), and S/N ratio (group A: 0.73±0.47, group B: 0.62±0.39) between the two groups were statistically significant (t=−2.528, −2.366, −2.514; P=0.016, 0.024, 0.017) but the difference in cTnI was not statistically significant. Multivariate Logistic regression analysis showed that the S/N ratio is an independent influencing factor of ΔLVEF (OR=2.164, P=0.018). ROC curve results showed that the S/N ratio could be used to predict the cut-off value (0.62) of ΔLVEF≥5% after PTCA treatment in AMI patients. The area under the curve was 0.823 (95%CI: 0.661–0.985), the specificity was 85.71%, and the sensitivity was 91.54%.
    Conclusion Radionuclide myocardial perfusion/metabolic imaging has important clinical value in evaluating left ventricular systolic function after PTCA treatment in AMI patients.

     

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