Clinic for Cardiology, Department for Diagnostic and Catheterization Laboratories, Clinical Center of Serbia, 8 Koste Todorovica, Belgrade, Serbia.
J Nucl Cardiol. 2010 Oct;17(5):817-24. doi: 10.1007/s12350-010-9251-1. Epub 2010 Jun 4.
In patients with previous myocardial infarction (MI), assessment of myocardial viability and physiological significance of coronary artery stenoses are essential for appropriate guidance of revascularization. The aim of the study was to evaluate the relation between fractional flow reserve (FFR) and myocardial viability as assessed by gated SPECT MIBI perfusion scintigraphy in patients with previous MI undergoing elective PCI.
The study population consisted of 26 patients (mean age 55 ± 7 years; 21 male) with a previous MI and a significant coronary stenosis in a single infarct-related coronary vessel for which PCI was being performed. In all patients, FFR was evaluated before and immediately after PCI. SPECT imaging was done before and 3 ± 1 months after PCI. A region representing the MI was considered viable if MIBI uptake was ≥55% of the normal region. Improvement in perfusion after revascularization was considered achieved if perfusion abnormalities decreased by 5% or more and there was a decrease in segmental score of ≥1 in three segments in PCI-related vascular territory.
Extent of perfusion abnormalities decreased from 32 ± 16% to 27 ± 19% after PCI (P < .001). In patients with myocardial viability in comparison to patients with no viability, there was significant difference in FFR before PCI (.57 ± .14 vs .76 ± .12, P = .002), despite almost the same values of diameter stenosis of infarct-related artery (63 ± 8% vs 64 ± 3%, respectively, P = .572). In addition, FFR prior to PCI was related to improvement in perfusion abnormalities after revascularization (P = .047), as well as with peak activity of creatine-kinase measured during previous MI (r = .56, P = .005).
Lower values of FFR before angioplasty are associated with myocardial viability and functional improvement as assessed by SPECT perfusion scintigraphy.
在有过心肌梗死（MI）病史的患者中，评估心肌存活性以及冠状动脉狭窄的生理意义对于适当指导血运重建至关重要。本研究旨在评估在接受择期经皮冠状动脉介入治疗（PCI）的既往 MI 患者中，血流储备分数（FFR）与门控 SPECT 心肌灌注闪烁显像评估的心肌存活性之间的关系。
研究人群包括 26 名（平均年龄 55 ± 7 岁；21 名男性）既往 MI 患者，这些患者的单一梗死相关冠状动脉存在显著狭窄，需要进行 PCI。所有患者在 PCI 前和即刻均进行了 FFR 评估。SPECT 成像在 PCI 前和 3 ± 1 个月后进行。如果 MIBI 摄取量大于正常区域的 55%，则认为该区域代表 MI 是存活的。如果灌注异常减少 5%或更多，且 PCI 相关血管区域的三个节段的节段评分降低≥1，则认为血运重建后灌注改善。
与没有存活心肌的患者相比，在 PCI 后，灌注异常的范围从 32 ± 16%减少到 27 ± 19%（P <.001）。在有存活心肌的患者中，与没有存活心肌的患者相比，在 PCI 前的 FFR 有显著差异（分别为 0.57 ± 0.14 和 0.76 ± 0.12，P =.002），尽管梗死相关动脉的直径狭窄程度几乎相同（分别为 63 ± 8%和 64 ± 3%，P =.572）。此外，在 PCI 前的 FFR 与血运重建后的灌注异常改善相关（P =.047），也与既往 MI 期间测量的肌酸激酶峰值活性相关（r =.56，P =.005）。
在接受经皮冠状动脉成形术之前，FFR 值较低与 SPECT 灌注闪烁显像评估的心肌存活性和功能改善相关。
