[通过门控心肌灌注显像相位分析评估陈旧性心肌梗死患者左心室收缩同步性]

[Left ventricular systolic synchrony assessed by phase analysis of gated myocardial perfusion imaging in patients with old myocardial infarction].

作者信息

Wang Jianfeng, Wang Yuetao, Zhang Xiaoli, Zhou Ruijue, Niu Rong, Lu Peiqi

机构信息

Department of Nuclear Medicine, First People's Hospital of Changzhou, Changzhou 213003, China.

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出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2015 Jul;43(7):599-604.

PMID:26420320

Abstract

OBJECTIVE

To assess the left ventricular (LV) systolic synchrony by phase analysis of gated myocardial perfusion imaging (GMPI) with SPECT/CT in patients with old myocardial infarction (OMI) and further to identify independent predictors for LV dyssynchrony.

METHODS

Seventy-six OMI patients and seventy-four healthy volunteers (control group) underwent resting GMPI from October 2010 to September 2013 in our hospital were included in this study. The left ventricular systolic synchrony parameters including phase histogram bandwidth (BW) and phase standard deviation (SD) were obtained by Cedars-Sinai quantitative gated SPECT (QGS) phase analysis technique, and LV cardiac function was also measured. The extent of myocardial perfusion defect was analyzed by the Quantitative Perfusion SPECT (QPS) software. The value of BW and SD were compared between OMI and the control groups, between LVEF ≤ 35% and LVEF > 35% groups in OMI patients. Dyssynchrony was defined when the BW exceeded the abnormality threshold derived from a normal control group (threshold = x ± 2s for normal BW).

RESULTS

(1) The BW ((91.3 ± 58.6)° vs. (37.2 ± 11.7)°) and SD ((27.3 ± 20.8)° vs. (11.8 ± 5.4)°) were significantly higher and the LVEF was significantly lower in OMI group than in the normal control group (all P < 0.01). In addition, BW ((136.0 ± 52.9)° vs. (51.0 ± 24.0)°) and SD ((38.7 ± 21.3)° vs. (17.1 ± 14.0)°) were significantly higher in patients with LVEF ≤ 35% than in patients with LVEF > 35% (all P < 0.001). (2) Dyssynchrony (BW > 60.6°) prevalence was 57.9% (44/76) in OMI patients. Compared with the synchrony group, LVEF was significantly lower, while the left ventricular end-diastolic volume, end-systolic volume, summed motion score, summed thickening score and extent were significantly higher in dyssynchrony group (all P < 0.001). (3) Additionally, dyssynchrony prevalence was significantly higher in patients with LVEF ≤ 35% compared with patients with LVEF > 35% (91.7% (33/36) vs. 27.5% (11/40), P < 0.001). (4) Pearson correlation analysis showed that LVEF was negatively correlated with BW (r = -0.807, P < 0.001). (5) Multivariate logistic regression analysis revealed that the extent of myocardial perfusion defect was an independent predictor for dyssynchrony in OMI patients (OR = 1.076, 95% CI: 1.015-1.141, P = 0.015).

CONCLUSIONS

GMPI phase analysis can reliably reflect left ventricular systolic synchrony. The left ventricular systolic dyssynchrony in OMI patients is significantly increased. Left ventricular dyssynchrony is closely related to LVEF. The extent of myocardial perfusion defect (Extent) is an independent predictor for left ventricular systolic dyssynchrony in OMI patients.

摘要

目的

通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）门控心肌灌注成像（GMPI）的相位分析评估陈旧性心肌梗死（OMI）患者的左心室（LV）收缩同步性，并进一步确定LV不同步的独立预测因素。

方法

本研究纳入了2010年10月至2013年9月在我院接受静息GMPI检查的76例OMI患者和74例健康志愿者（对照组）。通过雪松西奈定量门控SPECT（QGS）相位分析技术获得左心室收缩同步性参数，包括相位直方图带宽（BW）和相位标准差（SD），并测量LV心功能。采用定量灌注SPECT（QPS）软件分析心肌灌注缺损程度。比较OMI组与对照组之间、OMI患者中左心室射血分数（LVEF）≤35%和LVEF>35%组之间的BW和SD值。当BW超过正常对照组得出的异常阈值（正常BW的阈值=x±2s）时定义为不同步。

结果

（1）OMI组的BW（（91.3±58.6）°对（37.2±11.7）°）和SD（（27.3±20.8）°对（11.8±5.4）°）显著更高，LVEF显著低于正常对照组（均P<0.01）。此外，LVEF≤35%的患者的BW（（136.0±52.9）°对（51.0±24.0）°）和SD（（38.7±21.3）°对（17.1±14.0）°）显著高于LVEF>35%的患者（均P<0.001）。（2）OMI患者中不同步（BW>60.6°）患病率为57.9%（44/76）。与同步组相比，不同步组的LVEF显著更低，而左心室舒张末期容积、收缩末期容积、总运动评分、总增厚评分和范围显著更高（均P<0.001）。（3）此外，LVEF≤35%的患者的不同步患病率显著高于LVEF>35%的患者（91.7%（33/36）对27.5%（11/40），P<0.001）。（4）Pearson相关分析显示LVEF与BW呈负相关（r=-0.807，P<0.001）。（5）多因素逻辑回归分析显示心肌灌注缺损程度是OMI患者不同步的独立预测因素（比值比=1.076，95%置信区间：1.015-1.141，P=0.015）。