门控心肌灌注显像负荷总积分及相位分析对冠状动脉病变程度的评估价值

Assessment of the value of summed stress score and phase analysis of gated myocardial perfusion imaging in the severity of coronary artery lesion

    摘要
  • 摘要:
    目的探讨门控心肌灌注显像（GMPI）负荷总积分（SSS）及相位分析对冠状动脉（简称冠脉）病变程度的评估价值。
    方法入组先后行冠脉造影和99Tcm-甲氧基异丁基异腈两日法负荷-静息GMPI的胸痛患者89例，其中，经冠脉造影确诊冠状动脉粥样硬化性心脏病（简称冠心病）者52例（冠心病组），冠脉硬化者26例（冠脉硬化组），正常者11例（正常组）。冠脉病变程度由Gensini积分表示。采用17节段目测半定量法及定量门控心肌断层显像软件相位分析得出SSS和相位直方图带宽（BW）、相位标准差（SD）和熵，分析上述参数与Gensini积分的相关性，以及在冠心病组、冠脉硬化组及正常组之间的差异。统计学方法采用Kruskal-Wallis检验、单因素方差分析、相关分析、岭回归分析和配对t检验。
    结果（1）单因素分析结果显示，在病变程度不同的各组中，Gensini积分随GMPI各参数的增高而逐渐增高。（2）岭回归分析结果显示，BW是反映冠脉病变严重程度最显著的参数，其他依次为SSS、熵和SD（t=6.692、3.688、3.559和2.896，均P<0.05）。（3）冠心病组的SSS和静息BW、SD、熵与Gensini积分呈正相关（r=0.750、0.747、0.671和0.695，均P<0.05）。而冠脉硬化组及正常组的各参数与Gensini积分无明显相关性。冠心病组的静息BW（52.4°±20.6°）、SD（16.7°±7.7°）、熵（41.3%±8.0%）均显著大于冠脉硬化组（23.7°±7.4°、6.4°±2.9°、28.7%±8.0%），差异有统计学意义（F=8.299、8.176、6.752，均P<0.001），但冠脉硬化组与正常组间上述参数的差异均无统计学意义（F=1.462、0.812和1.422，均P>0.05）。89例患者的静息与负荷BW、SD、熵之间的差异均无统计学意义（t=0.283、1.121和0.726，均P>0.05）。
    结论SSS、BW、SD、熵在评估冠脉病变程度中具有一定的价值。静息、负荷GMPI相位分析对评价左室收缩同步性的价值相当。

     

    Abstract:
    ObjectiveTo assesse the value of summed stress score (SSS) and phase analysis of gated myocardial perfusion imaging (GMPI) in the severity of coronary artery lesion.
    MethodsEighty-nine patients with chest pain who underwent coronary angiography and 99Tcm-methoxyisobutylisonitrile (99Tcm-MIBI) two-day stress-rest GMPI were enrolled in this study. Among them, 52 patients were diagnosed with coronary heart disease by coronary angiography; 26 patients had coronary atherosclerosis and 11 patients were normal. The degree of coronary artery lesion was represented by Gensini score. SSS and phase histogram bandwidth (BW), standard deviation (SD), and entropy were derived using a 17-segment visual semi-quantitative method and the quantitative gated SPECT software phase analysis to analyze the correlation of the parameters with the Gensini score. The differences of the above parameters among coronary heart disease group, coronary artery sclerosis group, and normal group were compared. Kruskal-Wallis test, ANOVA, correlation analysis, ridge regression, and paired t test were used for statistical methods.
    Results(1) Univariate analysis showed that Gensini score gradually increased with the increase of GMPI parameters. (2)Ridge regression analysis showed that BW was the most significant parameter that reflected the severity of coronary artery lesion, followed by SSS, entropy, and SD(t=6.692, 3.688, 3.559 and 2.896, all P<0.05). (3)SSS, BW, SD, entropy of coronary heart disease group, and Gensini score were positively correlated (r=0.750, 0.747, 0.671 and 0.695, all P<0.05). No significant correlation was found between the parameters and Gensini score in the coronary artery sclerosis and normal groups. Rest GMPI analysis showed that BW(52.4°±20.6°), SD(16.7°±7.7°), and entropy(41.3%±8.0%) in coronary heart disease group were significantly higher than those in the coronary artery sclerosis group (23.7°±7.4°, 6.4°±2.9°, and 28.7%±8.0%, respectively; F=8.299, 8.176 and 6.752, all P<0.001). No significant difference was found in these parameters between coronary artery sclerosis group and normal group (F=1.462, 0.812 and 1.422, all P>0.05). The differences in BW, SD and entropy between rest and stress GMPI in 89 patients were not significantly different (t=0.283, 1.121 and 0.726, all P>0.05).
    ConclusionsSSS, BW, SD, and entropy have certain value in assessing the degree of coronary artery disease. Rest and stress GMPI have similar values in assessing left ventricular synchrony.

     

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