摘要
目的 探讨腺苷负荷.静息门控心肌灌注显像(G-MPI)评估冠状动脉粥样硬化性心脏病(简称冠心病)多支病变患者冠状动脉旁路移植术(CABG)后左心室(LV)心肌灌注、心功能及机械收缩同步性的价值.方法 回顾性收集2021年1月至2023年6月在昆明医科大学附属延安医院行CABG,并且于术前1周、术后6个月均进行G-MPI(一日法)的55例冠心病多支病变患者[男42例、女13例,年龄(59.3±9.0)岁];采用配对t检验或Wilcoxon符号秩检验比较CABG前、后LV心肌灌注参数[负荷总积分(SSS)、静息总积分(SRS)、差值总积分(SDS)]、心功能参数[LV射血分数(EF)、LV舒张末期容积(EDV)、LV收缩末期容积(ESV)、搏出量(SV)、高峰充盈率(PFR)]和机械收缩同步性参数[相位直方图带宽(PHB)和相位标准差(PSD)]差异;采用Wilcoxon符号秩检验比较负荷、静息显像间各指标CABG前、后变化值(△)的差异;通过Spearman秩相关分析静息LVEF、PFR与心肌灌注指标的关系.结果 CABG后患者SSS、SRS和SDS[6(3,12)、1(0,9)、3(1,5)分]均较术前降低[16(9,23)、4(1,15)、8(6,12)分;z 值:6.37、4.84、6.24,均 P＜0.001];静息及负荷 LVEF[60％(49％,67％)、58％(48％,68％)]、PFR[3.67(3.12,4.28)、3.23(2.77,4.43)EDV/s]均较术前增加[51％(33％,62％)、53％(27％,61％),2.76(2.08,3.52)、2.83(1.86,3.62)EDV/s;z 值:3.23～5.58,均 P＜0.01],LVEDV、LVESV 均较术前降低(t 值:6.40、5.27,z 值:5.33、5.40,均 P＜0.001);静息、负荷 PHB[45°(35°,70°)、53°(44°,113°)]和 PSD[14.7°(10.9°,27.3°)、20.0°(14.6°,33.8°)]均较术前降低[60°(45°,131°)、83°(58°,198°)、20.4°(16.0°,49.1°)、27.2°(19.6°,60.4°);z 值:4.19～4.81,均 P＜0.001];△SSS大于△SRS,静息 △PFR 大于负荷 △PFR(z 值:6.24、2.77,均P＜0.05).CABG 前、后,静息LVEF、静息PFR与SSS、SRS均呈负相关(rs值:-0.741～-0.431,均P＜0.05).结论 依据腺苷负荷-静息G-MPI获得的LV心肌灌注、心功能和机械收缩同步性信息能很好地评估患者CABG后恢复情况,该方法有助于更好地识别可能发生不良心脏事件的患者.
Abstract
Objective To explore the utility of adenosine stress-rest gated myocardial perfusion im-aging(G-MPI)in evaluation of left ventricular(LV)myocardial perfusion,heart function,and synchroni-zation in patients with multivessel coronary artery disease after coronary artery bypass grafting(CABG).Methods Fifty-five patients(42 males,13 females,age(59.3±9.0)years)with multivessel coronary ar-tery disease who underwent CABG surgery in Yan'an Hospital Affiliated to Kunming Medical University be-tween January 2021 and June 2023 were retrospectively collected.All of them underwent G-MPI(one-day method)one week before and six months after CABG.Paired t-test or Wilcoxon signed rank test was used to compare LV myocardial perfusion parameters including summed stress score(SSS),summed rest score(SRS),and summed different score(SDS)before and after CABG,as well as cardiac function parameters(LV ejection fraction(EF),LV end-diastolic volume(EDV),LV end-systolic volume(ESV),stroke vol-ume(SV),peak filling rate(PFR)),and LV mechanical contraction synchronization parameters such as phase histogram bandwidth(PHB)and phase standard deviation(PSD).Differences of the changes of pa-rameters after CABG compared to baseline(△)between adenosine stress imaging and rest imaging were also compared by Wilcoxon signed rank test.The relationships between rest LVEF,rest PFR and myocardial per-fusion parameters were analyzed by Spearman rank correlation analysis.Results After CABG,the SSS,SRS,and SDS were significantly lower than those before surgery(6(3,12)vs 16(9,23),1(0,9)vs 4(1,15),3(1,5)vs 8(6,12);z values:6.37,4.84,6.24,all P＜0.001);postoperative rest/stress LVEF(60％(49％,67％),58％(48％,68％))and PFR(3.67(3.12,4.28),3.23(2.77,4.43)EDV/s)signifi-cantly increased compared with preoperative values(51％(33％,62％),53％(27％,61％);2.76(2.08,3.52),2.83(1.86,3.62)EDV/s;z values:3.23-5.58,all P＜0.01);postoperative rest/stress LVEDV and LVESV were significantly lower than those before surgery(t values:6.40,5.27;z values:5.33,5.40;allP＜0.001);rest/stress PHB(45°(35°,70°),53°(44°,113°))and PSD(14.7°(10.9°,27.3°),20.0°(14.6°,33.8°))were significantly lower than those before surgery(60°(45°,131°),83°(58°,198°),20.4°(16.0°,49.1°),27.2°(19.6°,60.4°);z values:4.19-4.81,all P＜0.001).The △SSS was greater than the △SRS,and the △PFR was greater in rest imaging than that in stress imaging(z values:6.24,2.77,both P＜0.05).Rest LVEF,PFR were negatively correlated with SSS and SRS(rs values:from-0.741 to-0.431,all P＜0.05).Conclusion The LV myocardial perfusion,function,and mechanical contraction synchronicity information obtained from adenosine stress-rest G-MPI can be used to evaluate the recovery af-ter CABG,which may help to better identify patients who may have adverse cardiac events.
基金项目
兴滇英才支持计划"名医专项"(XDYC-MY-2022-0108)
云南省科技厅-昆明医科大学基础研究联合专项基金(202401AY070001-191)
春城计划"春城名医"专项(C202012021)
昆明市卫生科技人才培养项目暨技术中心建设项目(2020-SW技-24)
昆明市卫生科技人才培养基金(2023-SW后备-20)
NETL
NSTL
万方数据