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目的比较小剂量多巴酚丁胺超声心动图试验(LDDE)和~(99)Tc-甲氧基异丁腈(MIBI)/~(18)F-脱氧葡萄糖(FDG)双核素同时采集法(DISA)单光子发射型断层显像(SPECT)对急性心肌梗死早期存活心肌检出的准确性。方法对44例急性心肌梗死患者于发病后5～10天内行 LDDE和 DISA-SPECT,所有患者在 LDDE 和 DISA 检查后接受经皮冠状动脉介入术。两种方法均采用16节段半定量法分析图像。心肌梗死后3个月随访二维超声,以局部室壁运动改善作为心肌存活标准,比较两种方法检测存活心肌的敏感性和特异性。结果 LDDE 检出存活心肌的敏感性、特异性、诊断准确性、阳性预测值和阴性预测值分别为77%、82%、79%、82%和77%。DISA 检出存活心肌的敏感性、特异性、诊断准确性、阳性预测值和阴性预测值分别为85%、62%、74%、71%和79%。LDDE 和DISA 两者对运动异常节段检出存活心肌的一致性为70%。对于运动减低节段,LDDE 和 DISA 对存活心肌检出率差异无统计学意义(74.1%比77.6%,P>0.05);对于无运动节段,LDDE 对存活心肌检出率低于 DISA(29%比53%,P<0.01)。结论对急性心肌梗死后的患者,DISA 检出存活心肌的敏感性高于 LDDE,而特异性低于 LDDE,联合应用起互补作用,提高检测存活心肌的能力。
Objective To compare the effects of low dose dobutamine echocardiography (LDDE) and simultaneous extraction of ~ (99) Tc-methoxyisobutyronitrile (MIBI) / ~ (18) F-deoxyglucose DISA) single photon emission computed tomography (SPECT) in early detection of myocardial viability in acute myocardial infarction. Methods Forty-four patients with acute myocardial infarction underwent LDDE and DISA-SPECT within 5 to 10 days after onset. All patients underwent percutaneous coronary intervention after LDDE and DISA. Both methods used 16-segment semi-quantitative analysis of the image. Myocardial infarction 3 months follow-up two-dimensional ultrasound to improve the performance of local wall motion myocardial viability standards, compared with two methods to detect the sensitivity and specificity of viable myocardium. Results The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of LDDE for detecting viable myocardium were 77%, 82%, 79%, 82% and 77% respectively. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of DISA for viable myocardium were 85%, 62%, 74%, 71%, and 79%, respectively. Both LDDE and DISA were 70% consistent with detection of viable myocardium in an anomalous segment. There was no significant difference in the detection rate of viable myocardium between LDDE and DISA (74.1% vs. 77.6%, P> 0.05), while for LDM, the detection rate of LDDE was lower than that of DISA % Vs 53%, P <0.01). Conclusions In patients after acute myocardial infarction, the detection of viable myocardium by DISA is more sensitive than that of LDDE and less specific than LDDE, and the combined use of these two drugs complement each other and improve the ability to detect viable myocardium.