门控SPECT心肌灌注显像评估急性心肌梗死患者心肌挽救量的研究进展

Research progress of gated SPECT myocardial perfusion imaging in evaluating myocardial salvage in patients with acute myocardial infarction

  • 摘要: 急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)的目的在于尽可能地挽救濒死心肌。心肌挽救量(MS)与患者能否获益密切相关,在PCI的疗效评估及预后判断中具有重要价值。评价MS需明确初始心肌危险区面积(AAR)和心肌最终梗死面积(FIS),二者之差即为MS。通过急诊时和PCI后2次99Tcm-甲氧基异丁基异腈门控SPECT心肌灌注显像(GSMPI)可分别定量AAR和FIS,从而获得MS,结果客观、准确,其临床价值在早期的大样本研究中已得到肯定。但在急诊时行GSMPI受到很多限制,致使AAR较难获得。近年来有学者提出的新显像方案,仅通过PCI后早期行1次GSMPI即可测定AAR,替代了2次显像法计算得到MS,其可行性及在临床中的实用价值显著提高。同时,新显像方案也扩展了核素GSMPI在AMI诊疗中的应用范围,为AMI患者的危险度分层提供了补充信息。笔者拟对GSMPI评估AMI患者MS的新显像方案的机制、应用价值、优势及发展前景作一综述。

     

    Abstract: The purpose of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is to save dying myocardium as much as possible. The amount of myocardial salvage (MS) is closely related to whether the patients benefit from the PCI. MS is of great value for PCI efficacy evaluation and prognosis. To assess MS, the initial myocardial area at risk (AAR) before PCI and the final infarction size (FIS) after PCI should be determined, and the difference between the two is called MS. AAR and FIS can be quantified by double 99Tcm-methoxy-isobutyl-isonitrile gated SPECT myocardial perfusion imaging (GSMPI) on emergency admission and after PCI, respectively. The results are objective and accurate, and its clinical value has been confirmed in early large sample studies. However, emergency GSMPI has many limitations that make AAR difficult to obtain. In recent years, some scholars proposed that the only one GSMPI method early after PCI could replace double imaging method for MS evaluation, which significantly improved the feasibility and expanded the application extent of GSMPI in the diagnosis and treatment of AMI, and provided supplementary information for risk stratification in patients with AMI. The principle, application value, advantages and development prospect of the new method for evaluating MS in AMI patients are reviewed by authors.

     

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