The Evaluation of Effects of Coronary Artery Stenosis and Slow Coronary Flow on Myocardial Ischemia Using 99 Tcm-MIBI Myocardial Perfusion Imaging
Objective To describe imaging features of coronary artery stenosis and slow blood flow in nuclear myocardial perfusion tomography (MPI)and to explore the relationship between imaging features and coronary artery stenosis and slow blood flow.Methods 120 patients with 99 Tc m methoxy isobutyl acetonitrile (MIBI)resting MPI,nitroglycerin intervention MPI and coronary angiography were selected for the study.According to the results of coronary angiography,all patients were divided into a coronary stenosis group of 67 cases and a non-stenosis group of 53 cases.Additionally,46 patients with coronary stenosis<40％ were selected for coronary angiography.According to coronary flow velocity,they were divided into a slow flow group of 17 cases and a normal flow velocity group of 29 cases,Qualitative and semi-quantitative analysis were performed for MPI imaging results using ECToolbox software.Statistical analysis was conducted using SPSS 25.0 software.Results (1 )R-MPI detected a total of 464 segments with sparse perfusion,including 298 segments in the coronary stenosis group (4.45±1.41 per person)and 166 segments in the non-stenosis group (3.13±1.93 per person),with a statistically significant difference between the two groups (t=4.04,P<0.01);NTG-MPI detected a total of 528 segments with sparse perfusion,including 318 segments in the coronary artery stenosis group with an average of 4.75±2.16 segments per person,and 210 segments in the non-stenosis group with an average of 3.89±1.91 segments per person.There was no statistically significant difference between the two groups (t=1.91,P>0.05).The reverse redistribution rate of NTG-MPI in the group with coronary stenosis was 50.75％,while in the group without coronary stenosis it was 60.38％.There was no statistically significant difference between the two groups (x2=1.11,P>0.05).Among 46 patients with coronary artery stenosis<40％,R-MPI detected 150 segments of sparse perfusion,including 81 segments in the CSF group with an average of 4.76 ±1.44 segments per person,and 69 segments in the normal coronary blood flow velocity group with an average of 2.38±1.50 segments per person.The difference between the two groups was statistically significant (t=4.17,P<0.01).NTG-MPI detected 152 segments of sparse perfusion,including 103 segments in the CSF group with an average of 6.06±1.39 segments per person,and 49 segments in the normal coronary blood flow velocity group with an average of 1.69 ± 1.04 segments per person.The difference between the two groups was statistically significant (t=5.95,P<0.01).The reverse redistribution rate of NTG-MPI was 76.47％ in the CSF group,while it was 17.24％ in the normal coronary blood flow velocity group.There was a statistical difference between the two groups (x2=15.78,P<0.001).(2)The average scores of SRS,SSS,and SDS in patients with coronary stenosis were 12.42±3.83,17.82±4.32 and 5.40±2.08,respectively.The average scores of SRS,SSS and SDS in patients without coronary stenosis were 9.64±2.89,15.08±3.25 and 5.43±2.27,respectively.There were statistically significant differences in SRS and SSS between the two groups (t=4.45,P<0.01;t=3.82,P<0.01).The average scores of SRS,SSS and SDS in patients with slow coronary flow were 14.05±4.16,23.58±5.42 and 9.52±3.58,respectively.The average scores of SRS,SSS and SDS in patients with normal coronary flow velocity were 6.74±2.11,5.79±2.04 and -0.96±0.53,respectively.The differences in related indicators between the two groups were statistically significant (t=12.23,P<0.001,t=30.72;P<0.001 and t=12.23,P<0.001).There was a statistically significant difference in the semi-quantitative scores of R-MPI and NTG-MPI in the coronary slow flow group (t=12.6,P<0.001).(3)Among 17 patients in the CSF group,14 had SDS>0,accounting for 82.35％ (14/17),and 3 had SDS<0,accounting for 17.65％ (3/17).Among 29 patients with normal coronary blood flow velocity,3 had SDS>0,accounting for 10.34％,and 21 had SDS<0,accounting for 72.41％;The distribution of SDS showed statistical differences (Hc=42.20,P<0.05).For SDS>0,the average SDS scores of the CSF group and the normal coronary blood flow velocity group were 7.86±2.93 and 1.33±0.58,respectively with statistically significant differences between the two groups (t=2.87,P<0.05 ).Conclusion The number and uptake score of myocardial ischemic segments in MPI can reflect the range and degree of myocardial ischemia caused by coronary artery stenosis and slow coronary flow.NTG-MPI has more advantages in detecting myocardial ischemia caused by slow coronary flow."Reverse redistribution"is a characteristic imaging manifestation of coronary slow blood flow distinguishing from coronary stenosis in NTG-MPI.
万方数据
