Levy M, Bekri N, Pouillart F, Bellorini M, Romano M, Perez T, Palsky E
Service de cardiologie, HEP La Roserale, Aubervilliers.
Arch Mal Coeur Vaiss. 2000 Jul;93(7):827-34.
ECG-gated myocardial scintigraphy (Gspect) is a recent method of assessing myocardial perfusion, left ventricular ejection fraction and regional wall motion in a single investigation. It reduces the time required for the evaluation of coronary patients by radionucleide cardiology. Many reports have validated the measurement of the left ventricular ejection fraction compared with other methods. However, there are fewer series reporting the results of regional wall motion. The authors compared segmental wall motion by Gspect after injecting Thallium or Mibi and by transthoracic echocardiography in 47 patients or 423 myocardial segments. The concordance of score (normal, hypokinetic, akinetic, dyskinetic) was 75% (Kappa = 0.538). If analysis was limited to a normal-abnormal differentiation (binary analysis) it increased to 83%. When perfusion was taken into consideration, it was 81% (normal perfusion), 63% (mild hypoperfusion) and 70% (moderate and severe hypoperfusion). This concordance improved in binary analysis respectively to 85, 74 and 86% respectively. When the typs of segment was taken into consideration, concordance varied from 57 to 100%. The concordances were 74% for Thallium and 78% for Mibi scintigraphy, improving to 82% and 85% respectively in binary analysis. Thus, analysis of LV regional wall motion by Gspect is comparable to transthoracic echocardiography. This result, completed by measurement of LV ejection fraction and of myocardial perfusion, provides a method of evaluation of coronary patients in a single investigation.
心电图门控心肌闪烁显像（Gspect）是一种近期用于在单次检查中评估心肌灌注、左心室射血分数和局部室壁运动的方法。它缩短了放射性核素心脏病学评估冠心病患者所需的时间。许多报告已证实与其他方法相比，该方法在测量左心室射血分数方面的有效性。然而，报告局部室壁运动结果的系列研究较少。作者比较了47例患者或423个心肌节段在注射铊或甲氧基异丁基异腈后通过Gspect和经胸超声心动图得出的节段性室壁运动情况。评分（正常、运动减弱、运动消失、运动障碍）的一致性为75%（卡帕值=0.538）。如果分析仅限于正常与异常的区分（二元分析），则一致性提高到83%。当考虑灌注情况时，一致性分别为81%（正常灌注）、63%（轻度灌注不足）和70%（中度和重度灌注不足）。在二元分析中，这种一致性分别提高到85%、74%和86%。当考虑节段类型时，一致性在57%至100%之间变化。铊闪烁显像的一致性为74%，甲氧基异丁基异腈闪烁显像的一致性为78%，在二元分析中分别提高到82%和85%。因此，通过Gspect分析左心室局部室壁运动与经胸超声心动图相当。这一结果，再加上左心室射血分数和心肌灌注的测量，提供了一种在单次检查中评估冠心病患者的方法。
