Iskandrian A E, Kegel J G, Tecce M A, Wasserleben V, Cave V, Heo J
Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
Am Heart J. 1993 Nov;126(5):1199-203. doi: 10.1016/0002-8703(93)90675-y.
This study examined the left ventricular perfusion and EF by using simultaneous SPECT and first-pass radionuclide angiography with technetium 99m sestamibi in 95 patients after uncomplicated coronary artery bypass grafting. The patients were divided into those with normal EF and no previous myocardial infarction before surgery (group 1, n = 57), and those with abnormal EF or infarction (group 2, n = 38). The SPECT images were normal in 37 patients in group 1 and in 6 patients in group 2 (p < 0.0001). The patients with normal SPECT images had a higher EF after surgery than those with abnormal images (65% +/- 10% vs 50% +/- 14%, p < 0.0001) and was higher in group 1 than in group 2 (64% +/- 8% vs 46% +/- 16%, p < 0.0001). There was a significant correlation between the EF and the extent of perfusion abnormality (r = -0.44, p < 0.0001). The patients with normal SPECT images could not be separated from those with abnormal images based on peak CK, CK-MB, and the electrocardiographic changes. Of the 69 patients with postoperative EF > or = 50%, the perfusion pattern was normal in 41 and abnormal in 28; of the 26 patients with EF < 50%, 24 had abnormal SPECT (p < 0.003). There was no significant change in mean EF after surgery (55% +/- 14% before vs 56% +/- 15% after). Thus simultaneous assessment of left ventricular perfusion and function after coronary artery bypass grafting showed that an abnormal perfusion pattern may exist despite a normal EF. These patients could not be predicted by enzymes or electrocardiographic changes.
本研究采用锝99m甲氧基异丁基异腈同时进行单光子发射计算机断层扫描（SPECT）和首次通过放射性核素血管造影术，对95例无并发症冠状动脉旁路移植术后患者的左心室灌注和射血分数（EF）进行了检查。患者被分为术前EF正常且无心肌梗死病史者（第1组，n = 57）和EF异常或有梗死病史者（第2组，n = 38）。第1组37例患者和第2组6例患者的SPECT图像正常（p < 0.0001）。SPECT图像正常的患者术后EF高于图像异常者（65%±10% vs 50%±14%，p < 0.0001），且第1组高于第2组（64%±8% vs 46%±16%，p < 0.0001）。EF与灌注异常程度之间存在显著相关性（r = -0.44，p < 0.0001）。根据肌酸激酶（CK）峰值、肌酸激酶同工酶（CK-MB）和心电图变化，无法将SPECT图像正常的患者与图像异常的患者区分开来。在术后EF≥50%的69例患者中，41例灌注模式正常，28例异常；在EF<50%的26例患者中，24例SPECT异常（p < 0.003）。术后平均EF无显著变化（术前55%±14% vs术后56%±15%）。因此，冠状动脉旁路移植术后同时评估左心室灌注和功能显示，尽管EF正常，但可能存在异常灌注模式。这些患者无法通过酶或心电图变化进行预测。
