Danias P G, Ahlberg A W, Clark B A, Messineo F, Levine M G, McGill C C, Mann A, Clive J, Dougherty J E, Waters D D, Heller G V
Cardiology Division, Hartford Hospital, Connecticut 06102, USA.
Am J Cardiol. 1998 Nov 15;82(10):1253-8. doi: 10.1016/s0002-9149(98)00609-2.
The purpose of this study was to determine whether exercise technetium-99m sestamibi gated single-photon emission computed tomography (SPECT) accurately distinguishes between patients with ischemic cardiomyopathy and patients with nonischemic left ventricular systolic dysfunction. Noninvasive tests have previously failed to accurately separate patients with ischemic cardiomyopathy from those with nonischemic cardiomyopathy. Technetium-99m gated SPECT imaging offers advantages that have the potential to overcome the limitations of previous studies. Thirty-seven adults with a left ventricular ejection fraction < or = 35%, including 24 patients with nonischemic cardiomyopathy and 13 patients with ischemic cardiomyopathy, were prospectively evaluated using symptom-limited metabolic exercise treadmill testing with technetium-99m sestamibi gated SPECT imaging. Interpretation of myocardial perfusion and regional wall motion was performed, using a 17-segment model. Summed stress, rest, and reversibility perfusion defect scores were determined, and the variance of segmental wall motion scores was computed. Summed stress, rest, and reversibility perfusion defect scores were significantly lower in nonischemic cardiomyopathy patients, compared with those with ischemic cardiomyopathy (summed stress defect score: 6.9 +/- 3.8 vs 32.9 +/- 7.7, respectively, p <0.001). Variability in segmental wall motion was also significantly lower in patients with nonischemic cardiomyopathy compared with those with ischemic cardiomyopathy (variance: 0.3 +/- 0.3 vs 1.2 +/- 0.8, respectively, p <0.001). Thus, assessment of myocardial perfusion and regional ventricular function with exercise technetium-99m sestamibi gated SPECT imaging can reliably distinguish between patients with ischemic cardiomyopathy and patients with nonischemic dilated cardiomyopathy.
本研究的目的是确定运动锝-99m 甲氧基异丁基异腈门控单光子发射计算机断层扫描（SPECT）能否准确区分缺血性心肌病患者和非缺血性左心室收缩功能障碍患者。此前，无创检查未能准确将缺血性心肌病患者与非缺血性心肌病患者区分开来。锝-99m 门控 SPECT 成像具有一些优势，有可能克服既往研究的局限性。对 37 名左心室射血分数≤35%的成年人进行了前瞻性评估，其中包括 24 名非缺血性心肌病患者和 13 名缺血性心肌病患者，采用症状限制性代谢运动平板试验及锝-99m 甲氧基异丁基异腈门控 SPECT 成像。使用 17 节段模型对心肌灌注和节段性室壁运动进行解读。确定了负荷、静息和可逆性灌注缺损总分值，并计算节段性室壁运动评分的方差。与缺血性心肌病患者相比，非缺血性心肌病患者的负荷、静息和可逆性灌注缺损总分值显著更低（负荷灌注缺损总分值：分别为 6.9±3.8 和 32.9±7.7，p<0.001）。与缺血性心肌病患者相比，非缺血性心肌病患者节段性室壁运动的变异性也显著更低（方差：分别为 0.3±0.3 和 1.2±0.8，p<0.001）。因此，运动锝-99m 甲氧基异丁基异腈门控 SPECT 成像评估心肌灌注和局部心室功能能够可靠地区分缺血性心肌病患者和非缺血性扩张型心肌病患者。
