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目的:比较小剂量腺苷负荷超声心动图试验(LDASE)与99mTc-甲氧基异丁腈(MIBI)/18F-脱氧葡萄糖(FDG)双核素同时采集法(DISA)单光子发射断层显像(SPECT)对急性心肌梗死(AMI)患者早期存活心肌检出的准确性。方法:对36例AMI患者于发病后3～10d内行LDASE与DISA-SPECT。所有患者在LDASE前后接受经皮冠状动脉介入治疗术。AMI后3个月随访二维超声心动图,以局部室壁运动改善作为心肌存活的金标准,比较2种方法检测存活心肌的敏感性和特异性。结果:LDASE检出存活心肌敏感性为90.3%,特异性为80.8%,阳性预测值与阴性预测值分别为84.8%和87.5%,准确性为86.0%;DISA-SPECT检出存活心肌敏感性81.2%,特异性78.3%,阳性预测值81.1%,阴性预测值83.1%,准确性80.2%。2种方法对运动异常节段存活心肌检出一致性为72.6%,差异无统计学意义。结论:对AMI后患者,LDASE与DISA-SPECT均为检出存活心肌较敏感和特异的技术。
OBJECTIVE: To compare the effects of low dose adenosine stress echocardiography (LDASE) and 99mTc-MIBI / 18F-FDG dual-isotope simultaneous acquisition (DISA) single photon emission tomography SPECT) in the detection of early surviving myocardium in patients with acute myocardial infarction (AMI). Methods: Thirty-six AMI patients underwent LDASE and DISA-SPECT within 3-10 days after onset. All patients underwent percutaneous coronary intervention before and after LDASE. Two-dimensional echocardiography was followed up 3 months after AMI to improve the local ventricular wall motion as the gold standard for myocardial survival. The sensitivity and specificity of two methods were compared. Results: The sensitivity and specificity of LDase in detecting myocardial viability were 90.3%, 80.8%, 84.8%, 87.5%, respectively, with accuracy of 86.0%; DISA-SPECT detection of myocardial viability was 81.2% %, Specificity 78.3%, positive predictive value 81.1%, negative predictive value 83.1%, accuracy 80.2%. The coincidence of the two methods in detecting myocardial viable myocardium was 72.6%, the difference was not statistically significant. CONCLUSIONS: LDASE and DISA-SPECT are both sensitive and specific for the detection of viable myocardium in post-AMI patients.