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目的采用MIBI+18F-FDG心肌灌注-代谢显像(DISA)评价冠心病心肌梗死患者存活心肌有或无收缩潜能,及其对临床决策的影响。方法选择临床确诊并行冠状动脉造影(CAG)的心肌梗死患者72例行DISA显像。根据DISA结果将本组病例分为存活心肌≥4个节段(A组)和存活心肌<4个节段(B组)两组,以小剂量多巴酚丁胺负荷心脏超声(LD-DSE)观察负荷前后结果。结果 72例心肌梗死患者共检出灌注缺损438个节段,其中A组250(6.6±3.4)个节段;B组188(4.6±1.8)个节段;t=7.32,P<0.001。共检出代谢缺损223个节段,其中A组158(5.0±2.6)个节段;B组65(2.7±1.2)个节段;t=6.83,P<0.001。Dob负荷状态下共检出室壁运动改善197个节段,其中A组71(2.1±1.4)个节段;B组126(3.6±2.3)个节段;t=4.57,P<0.001。DSE室壁运动指数(WMSI):A组同组静息与Dob负荷相比,t=6.33,P<0.001,B组同组静息与Dob负荷相比,t=10.11,P<0.001;无论是静息状态还是Dob负荷状态,A组和B组相比t=12.01、14.84,P<0.001。结论判断心肌梗死区存活心肌的多少及其恢复功能的潜能是临床治疗决策的重要依据,DISA-MIBI和LD-DSE联合检测可能是具有最大化决策指导价值的方法。
Objective To evaluate the effect of MIBI + 18F-FDG myocardial perfusion-metabolic imaging (DISA) on the presence or absence of viable myocardium in patients with myocardial infarction (CHD) and its impact on clinical decision-making. Methods Seventy-two patients with myocardial infarction who underwent coronary angiography (CAG) undergoing clinical diagnosis were examined with DISA. According to the results of DISA, the patients were divided into two groups: ≥4 segments of surviving myocardium (group A) and <4 segments of surviving myocardium (group B). Low-dose dobutamine stress echocardiography (LD-DSE ) Observe the results before and after the load. Results A total of 438 segments of perfusion defects were detected in 72 patients with myocardial infarction, including 250 (6.6 ± 3.4) segments in group A and 188 (4.6 ± 1.8) segments in group B; t = 7.32, P <0.001. A total of 223 segments of metabolic defects were detected, including 158 (5.0 ± 2.6) segments in group A and 65 (2.7 ± 1.2) segments in group B; t = 6.83, P <0.001. A total of 197 segments of wall motion improvement were detected at Dob loading, with 71 (2.1 ± 1.4) segments in group A and 126 (3.6 ± 2.3) segments in group B; t = 4.57, P <0.001. DSE wall motion index (WMSI): Resting in group A compared with Dob load, t = 6.33, P <0.001, Resting in group B compared with Dob load, t = 10.11, P <0.001; Is resting or Dob load status, A and B compared t = 12.01, 14.84, P <0.001. Conclusion The determination of the number of viable myocardium in myocardial infarction area and the potential of its recovery function are important basis for clinical treatment decision-making. Combined detection of DISA-MIBI and LD-DSE may be the method to maximize the value of decision guidance.