Maeba Hirofumi, Takehana Kazuya, Nakamura Seishi, Yoshida Susumu, Ueyama Takanao, Hatada Kengo, Iwasaka Toshiji
Division of Cardiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, Japan.
Ann Nucl Med. 2008 May;22(4):309-16. doi: 10.1007/s12149-008-0117-4. Epub 2008 Jun 6.
Although the accurate detection of ischemic etiology is important in the management of patients with severe left ventricular (LV) dysfunction, it is difficult to determine using a non-invasive strategy. The present study investigates whether perfusion and regional functional abnormalities identified by quantitative electrocardiographic gated single-photon emission computed tomography (QGS) at rest can detect ischemic LV dysfunction in patients with severe LV dysfunction.
Rest QGS with (99m)Tc-tetrofosmin was performed on 54 consecutive patients with LV ejection fraction of </=40%. Ischemic LV dysfunction (n = 32) was defined according to the established standard. Regional perfusion and wall motion were calculated using a 14-segment model (six mid-ventricular and eight apical segments) and compared with a normal control group.
The numbers of reduced [mean -1 standard deviation (SD) of normal individuals] and severely reduced (mean -2 SD) wall motion segments were similar between patients with ischemic and non-ischemic LV dysfunction (13.5 +/- 1.1 vs. 13.6 +/- 0.9 and 10.6 +/- 2.0 vs. 9.9 +/- 3.0 segments, respectively). The number of hypoperfused (mean -1 SD) segments was significantly greater in patients with ischemic LV dysfunction than in those with non-ischemic LV dysfunction (9.3 +/- 3.8 vs. 2.0 +/- 2.8 segments, P < 0.0001). The analysis of the receiver operating characteristics showed that a cut-off value of 4 hypoperfused segments among 14 segments provided the best separation between ischemic and non-ischemic LV dysfunction (sensitivity = 88% and specificity = 91%). Furthermore, patients with non-ischemic LV dysfunction had no severely hypoperfused (mean -2 SD) segments in any of the segments, whereas patients with ischemic LV dysfunction had 4.4 +/- 0.2 segments.
The QGS strategy at rest can accurately differentiate patients with ischemic LV dysfunction from those with severe LV dysfunction by simultaneous regional evaluation of wall motion and myocardial perfusion.
尽管准确检测缺血病因对于严重左心室（LV）功能障碍患者的管理很重要，但使用非侵入性策略很难确定。本研究调查静息状态下通过定量心电图门控单光子发射计算机断层扫描（QGS）识别的灌注和局部功能异常是否能检测出严重LV功能障碍患者的缺血性LV功能障碍。
对54例连续的LV射血分数≤40%的患者进行静息状态下用（99m）锝替曲膦的QGS检查。根据既定标准定义缺血性LV功能障碍（n = 32）。使用14节段模型（6个心室中段节段和8个心尖节段）计算局部灌注和室壁运动，并与正常对照组进行比较。
缺血性和非缺血性LV功能障碍患者中，室壁运动节段减少[正常个体平均值-1标准差（SD）]和严重减少（平均值-2 SD）的数量相似（分别为13.5±1.1节段对13.6±0.9节段和10.6±2.0节段对9.9±3.0节段）。缺血性LV功能障碍患者中灌注不足（平均值-1 SD）节段的数量显著多于非缺血性LV功能障碍患者（9.3±3.8节段对2.0±2.8节段，P < 0.0001）。受试者工作特征分析表明，14个节段中4个灌注不足节段的截断值能最好地区分缺血性和非缺血性LV功能障碍（敏感性 = 88%，特异性 = 91%）。此外，非缺血性LV功能障碍患者在任何节段均无严重灌注不足（平均值-2 SD）节段，而缺血性LV功能障碍患者有4.4±0.2节段。结论：静息状态下的QGS策略可通过同时对室壁运动和心肌灌注进行局部评估，准确区分缺血性LV功能障碍患者和严重LV功能障碍患者。
