Sotgia Barbara, Sciagrà Roberto, Parodi Guido, Kastrati Adnan, Antoniucci David, Schömig Albert, Pupi Alberto
Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
Eur J Nucl Med Mol Imaging. 2008 May;35(5):906-11. doi: 10.1007/s00259-007-0663-3. Epub 2007 Dec 11.
We hypothesized that, because of persistent stunning, the extent of post-treatment functional abnormalities detected using gated single-photon emission computed tomography (SPECT) could be representative of the initial risk area in acute myocardial infarction (AMI) treated by reperfusion therapy.
In 48 AMI patients, we acquired two 99mTc-sestamibi gated SPECT studies (at admission with tracer injection before treatment and at discharge 5 to 10 days later). We assessed the myocardial salvage defined by the admission minus predischarge summed rest score, and we compared it with the value obtained by subtracting the extent of perfusion defect from the extent of wall motion or wall thickening abnormalities in predischarge gated SPECT. Myocardial salvage was expressed as salvage index (salvaged myocardium divided by initial risk area).
There was a good correlation between summed rest score salvage index and wall motion (Spearman's rho = 0.754, p < 0.0001) or wall thickening salvage index (Spearman's rho = 0.798, p < 0.0001). The wall thickening salvage index was able to classify correctly the patients that had a summed rest score salvage index > or = 0.10 with 73% sensitivity, 88% specificity, and 83% accuracy. The wall motion salvage index was highly sensitive (91%) but poorly specific (13%, p < 0.002 vs wall thickening salvage index) and less accurate (69%, p < 0.05 vs wall thickening salvage index).
99mTc-sestamibi gated SPECT allows assessing myocardial salvage using only post-treatment data. The salvage index derived using wall thickening as surrogate of admission perfusion defect correlates well with the salvage index measured by comparing pre- and post-treatment perfusion defects.
我们推测，由于持续性心肌顿抑，使用门控单光子发射计算机断层扫描（SPECT）检测到的治疗后功能异常程度可能代表接受再灌注治疗的急性心肌梗死（AMI）的初始风险区域。
对48例AMI患者进行了两项99mTc-甲氧基异丁基异腈门控SPECT研究（入院时治疗前注射示踪剂，5至10天后出院时）。我们评估了通过入院时减去出院前静息积分总和定义的心肌挽救情况，并将其与通过出院前门控SPECT中壁运动或壁增厚异常程度减去灌注缺损程度获得的值进行比较。心肌挽救情况以挽救指数表示（挽救的心肌除以初始风险区域）。
静息积分总和挽救指数与壁运动（Spearman秩相关系数=0.754，p<0.0001）或壁增厚挽救指数（Spearman秩相关系数=0.798，p<0.0001）之间存在良好的相关性。壁增厚挽救指数能够以73%的敏感性、88%的特异性和83%的准确性正确分类静息积分总和挽救指数≥0.10的患者。壁运动挽救指数敏感性高（91%）但特异性差（13%，与壁增厚挽救指数相比p<0.002）且准确性较低（69%，与壁增厚挽救指数相比p<0.05）。
99mTc-甲氧基异丁基异腈门控SPECT仅使用治疗后数据即可评估心肌挽救情况。使用壁增厚作为入院时灌注缺损替代指标得出的挽救指数与通过比较治疗前后灌注缺损测量的挽救指数相关性良好。
