Bestetti Alberto, Cuko Besart, Gasparini Massimo, De Servi Stefano
Department of Clinical and Biomedical Sciences, University of Milan, Milan, Italy.
Department of Nuclear Medicine, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy.
J Nucl Cardiol. 2020 Feb;27(1):137-146. doi: 10.1007/s12350-018-1340-6. Epub 2018 Jun 27.
The aim of the present study was to assess the additional value of systolic wall thickening to myocardial perfusion in diagnosing myocardial stunning induced by dipyridamole infusion. We selected 52 ischemic patients (43 males; mean age 65.5 ± 7.64), with CAD documented by angiography. Ischemia was defined as a summed difference score ≥ 5. All patients underwent a 2-day gated perfusion SPECT protocol. The patients received a dose of 740 MBq of 99mTc-tetrofosmin after stress and at rest.
The post-stress LVEF was significantly lower than rest LVEF (48.3% ± 14.5% vs. 50.7% ± 15%; P = 0.0001). The wall thickening summed difference score was 3.97 ± 3.84 (P = 0.0001). At a multivariate regression analysis, only WT-SDS as independent variable was significantly correlated with myocardial ischemia (SDS) (P = 0.001). We divided patients according to SDS in those with mild (SDS < 8) and severe (SDS ≥ 8) ischemia. WT-SDS, but not ∆LVEF, was significantly different between groups.
WT-SDS showed a better correlation with the degree of ischemia than the depression in the global function of the left ventricle. It allowed to better identify the stunning phenomenon in patients submitted to pharmacological stress.
本研究的目的是评估收缩期室壁增厚对心肌灌注在诊断双嘧达莫输注所致心肌顿抑中的附加价值。我们选取了52例缺血性患者（43例男性；平均年龄65.5±7.64岁），其冠状动脉疾病经血管造影证实。缺血定义为总差异评分≥5。所有患者均接受为期2天的门控灌注单光子发射计算机断层扫描（SPECT）方案。患者在负荷及静息状态下接受740MBq的99mTc - 替曲膦剂量。
负荷后左心室射血分数（LVEF）显著低于静息LVEF（48.3%±14.5%对50.7%±15%；P = 0.0001）。室壁增厚总差异评分为3.97±3.84（P = 0.0001）。在多变量回归分析中，仅室壁增厚总差异评分（WT - SDS）作为自变量与心肌缺血（SDS）显著相关（P = 0.001）。我们根据SDS将患者分为轻度（SDS < 8）和重度（SDS≥8）缺血组。WT - SDS在两组间有显著差异，而LVEF差值（∆LVEF）无显著差异。
与左心室整体功能降低相比，WT - SDS与缺血程度的相关性更好。它能更好地识别接受药物负荷的患者中的顿抑现象。
