SPECT在冠心病危险度分层方面的应用

陈小明

SPECT在冠心病危险度分层方面的应用

陈小明

文章导航 > 国际放射医学核医学杂志 > 2004, 28 > 3: (101-105)

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SPECT在冠心病危险度分层方面的应用

陈小明

510632 广州, 暨南大学附属第一医院心内科
中图分类号: R541.4;R817.4

Risk stratification assessed by single photon emission computed tomography in coronary artery disease

CHEN Xiao-ming

Department of Cardiovasology of the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
CLC number: R541.4;R817.4

摘要: 应用门控心肌灌注SPECT测得的心肌灌注缺损和负荷后左室射血分数(left ventricular ejection fraction,LVEF)相结合进行危险度分层,对非致死性心肌梗死和心脏性死亡的风险进行评估以指导临床选择最佳治疗方案。对于射血分数(ejection fraction, EF) ≥ 30%,总差值分(即总负荷评分与总静息评分的差值,summed difference score, SDS)>7的中高危患者,宜进行血流重建术(revascularization);SDS为2~7的患者,若EF>50%则为低危,可给予药物治疗,而EF为30%~50%者则予药物治疗及血流重建术;若为未见心肌缺血的极低危患者,则宜药物治疗。
- 单光子发射计算机体层显像 /
- 冠心病 /
- 危险度分层
Abstract: Using the combination of the myocardial perfusion and poststress ejection fraction(EF) by the gated myocardial SPECT in the risk stratification for the patients who had coronary artery diseases to assess the risk of nonfatal myocardial infarction versus cardiac death can assist in determining the appropri-ate treatment strategy for the individual patient. With EF≥30% and SDS(summed difference score)>7, the patients who are at intermediate or higher risk of cardiac death might benefit more from revasculariza-tion; patients with SDS 2~7 and EF>50% are at low risk and aggressive medical therapy might be pre-ferred; while those with EF 30%~50% are at intermediate risk and might benefit more from early invasive strategy in conjunction with medical therapy; and the patients with no evidence of ischemia on perfusion imaging, who have very low risk of cardiac death and therefore, might benefit more from initial medical therapy.
- single photon emission computed tomography /
- coronary artery disease /
- risk stratification
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[1]	Elhendy A, Bax JJ, Poldermans D. Dobutamine Stress Myocardial Perfusion Imaging in Coronary Artery Disease[J]. J Nucl Med, 2002, 43(12):1634-1646.
[2]	Sharir T, Germano G, Kang XP, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT:Risk stratification by the Amount of Stress-Induced Ischemia and the Poststress Ejection Fraction[J]. J Nucl Med, 2001, 42(6):831-837.
[3]	Pitt B, Water D, Brown WV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease:atorvastatin versus revasularization treatment investigators[J]. N Engl J Med, 1999, 341(8):70-76.
[4]	Sharir T, Germano G, Kavanagh PB, et al. Incremental prognostic value of poststress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography[J]. Circulation, 1999,100(9):1035-1042.
[5]	Germano G, Kavanagh PB, Chen J, et al. Operator-Jess processing of myocardial perfusion SPECT studies[J]. J Nucl Med, 1995, 36(11):2127-2132.
[6]	Hachemovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death:differential stratification for risk of cardiac death and myocardial infarction[J].Circulation, 1998,97(2):535-543
[7]	Ambrose JA, Tannenbaum MA, Alexopoulos D, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction[J]. J Am Coll Cardiol, 1998, 12(1):56-62.
[8]	Shah PK. Plaque size, vessel size and plaque vulnerability:higger may not be better[J]. J Am Coll Cardiol, 1998,32(9):663-664.
[9]	Johnson LL, Verdesca SA, Aude WY, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms[J]. J Am Coll Cardiol, 1997, 30(7):1641-1648.
[10]	Bavelaar-Croon CDL, Atsma DE, Wall VDEE, et al. The additive value of gated SPET myocardial perfusion imaging in patients with known and suspected coronary artery disease[J]. J Nucl Med, 2001, 22(1):45-55.
[11]	Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival:overview of 10-years results from randomized trials by the Coronary Artery Bypass Graft Surgery T rialists Collaboration[J].Lancet, 1994, 344(8922):563-570.
[12]	RITA-2 trial participants. Coronary angioplasty versus medical therapy for angina:The Second Randomized Intervention Treatment of Angina (RITA-2) trial[J]. Lancet,1997, 350(9076):461-468.
[13]	Dakik HA, Mahmarian JJ, Kimball KT, et al. Prognostic value of exercise ²⁰¹Tl tomography in patients treated with thrombolytic therapy during acute myocardial infarction[J].Circulation, 1996, 94(12):2735-2742.
[14]	Angeja BG, Gunda M, Murphy SA, et al. TIMI myocardial perfusion grade and ST segment resolution:Association with infarct size as assessed by single photon emission computed tomography imaging[J]. Circulation, 2002, 105(1):282-285.
[15]	Giri S, Shaw LJ, Murthy DR, et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease[J]. Circulation, 2002(1),105:32-40.
[16]	Miller DD, Stratmann HG, Shaw L, et al. Dipyridamole technetium 99m sestamibi myocardial tomography as an independent predictor of cardiac event-free survival after acute ischemic events[J]. J Nucl Cardiol, 1994, 1(1):72-82.
[17]	Stratmann HG, Younis LT, Wittry MD, et al. Dipyridamole technetium 99m sestamibi myocardial tomography for preoperative cardiac risk stratification before major or minor nonvascular surgery[J]. Am Heart J, 1996, 132(3):536-541.

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SPECT在冠心病危险度分层方面的应用

陈小明

510632 广州, 暨南大学附属第一医院心内科

收稿日期: 2003-12-06

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摘要: 应用门控心肌灌注SPECT测得的心肌灌注缺损和负荷后左室射血分数(left ventricular ejection fraction,LVEF)相结合进行危险度分层,对非致死性心肌梗死和心脏性死亡的风险进行评估以指导临床选择最佳治疗方案。对于射血分数(ejection fraction, EF) ≥ 30%,总差值分(即总负荷评分与总静息评分的差值,summed difference score, SDS)>7的中高危患者,宜进行血流重建术(revascularization);SDS为2~7的患者,若EF>50%则为低危,可给予药物治疗,而EF为30%~50%者则予药物治疗及血流重建术;若为未见心肌缺血的极低危患者,则宜药物治疗。