冠状动脉左前降支慢性完全闭塞病变中侧支循环与心肌存活的心肌放射性核素显像研究

发布时间：2018-11-04 09:36

【摘要】：目的:评价冠状动脉侧支循环与心肌存活在冠状动脉左前降支慢性完全闭塞病变中的作用。方法:研究纳入101例于我院临床确诊为冠状动脉左前降支慢性完全闭塞病变患者,其中男性86例,女性15例,平均年龄(59.92±11.43)岁。所有患者均行~(99m)Tc-甲氧基异丁基异腈(MIBI)心肌灌注显像和门控~(18)F-氟代脱氧葡萄糖(FDG)心肌代谢显像,且在前后3个月内接受过冠状动脉造影。将心肌灌注图像与心肌代谢显像进行同机重建,使用QPS软件分别得到静息灌注总积分(SRS)、总灌注缺损面积(TPD)、心肌灌注/代谢不匹配(存活心肌)面积、心肌灌注/代谢匹配(无存活心肌)面积,利用QGS软件对心肌代谢图像进行分析,得到左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)。根据冠状动脉造影结果分为有侧支循环组(n=39)、无侧支循环组(n=62),比较两组之间SRS、TPD、心肌灌注/代谢不匹配面积、心肌灌注/代谢匹配面积、门控心功能参数(LVEDV、LVESV、LVEF)之间的差异;进一步根据患者有无陈旧性心肌梗死、左前降支慢性完全闭塞部位各分为4个亚组,比较上述各项参数的差异,从而探讨侧支循环在其中的作用。结果:患者中有侧支循环组39例(38.61%),无侧支循环组62例(61.39%);两组静息灌注总积分[(21.23±9.68)vs(28.56±8.76)]、灌注异常面积(30.03±13.69)%vs(40.37±12.50)%相比,差异均有统计学意义(P均0.05)。有侧支循环组心肌灌注/代谢不匹配面积(21.77±13.12)%、心肌灌注/代谢匹配面积(8.28±8.58)%,与无侧支循环组灌注/代谢不匹配面积(13.66±9.23)%、灌注/代谢匹配面积(27.40±12.97)%相比,差异均有统计学意义(P均0.05)。两组LVEDV[(109.82±30.01)mlvs(173.71±57.69)ml]、LVESV[(62.82±22.39)mlvs(122.53±51.66)ml]、LVEF[(43.85±8.46)%vs(31.03±8.30)%]相比,差异均有统计学意义(P均0.05)。结论:本研究初步发现,对于冠状动脉左前降支慢性完全闭塞病变的患者,冠状动脉侧支循环可以维持左心室静息心肌血流灌注、维持心肌存活、保护左心室心功能。
[Abstract]:Aim: to evaluate the role of collateral circulation and myocardial survival in chronic total occlusion of left anterior descending coronary artery. Methods: 101 patients (86 male and 15 female with mean age of (59.92 卤11.43) years) with chronic total occlusion of left anterior descending coronary artery were enrolled in the study. All patients underwent ~ (99m) Tc- (MIBI) myocardial perfusion imaging and gated ~ (18) F-fluorodeoxyglucose (FDG) myocardial metabolism imaging, and underwent coronary angiography within 3 months. Myocardial perfusion images and myocardial metabolism imaging were reconstructed on the same machine. The total (SRS), perfusion defect area (TPD),) perfusion / metabolic mismatch area (surviving myocardium) was obtained by QPS software. Myocardial perfusion / metabolic matching (no viable myocardium) area was analyzed by QGS software. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF).) were obtained. According to the results of coronary arteriography, the patients were divided into two groups: collateral circulation group (n ~ 39) and non-collateral circulation group (n ~ (62). The myocardial perfusion / metabolic mismatch area, myocardial perfusion / metabolic matching area and gated cardiac function parameters (LVEDV,) were compared between the two groups. (LVESV,LVEF); The patients were further divided into 4 subgroups according to whether the patients had old myocardial infarction and chronic complete occlusion of left anterior descending branch. The differences of the above parameters were compared to explore the role of collateral circulation in it. Results: there were 39 cases (38.61%) in collateral circulation group and 62 cases (61.39%) in non-collateral circulation group. The total resting perfusion score [(21.23 卤9.68) vs (, 28.56 卤8.76)] and the abnormal perfusion area (30.03 卤13.69)% vs (40.37 卤12.50)% were significantly different between the two groups. Myocardial perfusion / metabolism mismatch area was (21.77 卤13.12)%, myocardial perfusion / metabolic mismatch area was (8.28 卤8.58)% in collateral circulation group and (13.66 卤9.23)% in non-collateral circulation group. The perfusion / metabolism matching area was (27.40 卤12.97)%, the difference was statistically significant (P 0.05). LVEDV [(109.82 卤30.01) mlvs (173.71 卤57.69) ml], LVESV [(62.82 卤22.39) mlvs (122.53 卤51.66) ml] and LVEF [(43.85 卤8.46)% vs (31.03 卤8.30)%] were compared between the two groups. The difference was statistically significant (P 0.05). Conclusion: in the patients with chronic total occlusion of the left anterior descending coronary artery, the collateral circulation of the coronary artery can maintain the left ventricular resting myocardial perfusion, maintain the myocardial survival and protect the left ventricular heart function.
【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外医院核医学科;
【基金】：国家自然科学基金(81320108014) 十二五国家科技支撑计划(2011BAI11B02)
【分类号】：R543.3

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