摘要目的 比较18F脱氧葡萄糖(18 F-FDG) PET/CT心肌葡萄糖代谢显像与侧支循环形成对于评价冠状动脉慢性闭塞性病变(CTO)患者心功能预后价值.方法 收集2016年4月至2017年4月在北京安贞医院就诊的CTO患者60例,1周内完成99mTc甲氧基异丁基乙腈(99mTc-MIBI)静息门控心肌灌注单光子发射计算机断层扫描(SPECT)/CT(GSPECT)显像和18F-FDG门控心肌葡萄糖代谢正电子发射计算机断层扫描(PET)/CT显像(GPET),评价存活心肌及左心室功能,冠状动脉造影检测评价CTO病变的位置及侧支循环形成.GPET数据采用定量门控心脏断层软件QGS分析,获取左心室功能参数,包括舒张末期容积(EDV),收缩末期容积参数(ESV)和左心室射血分数(LVEF).侧支循环形成的程度应用Rentrop分级评价.全部入选研究对象随访12 ～ 20个月,以美国纽约心脏病学会(NYHA)心功能分级评估心功能,比较18F-FDG PET/CT心肌葡萄糖代谢显像与侧支循环形成对于CTO患者心功能预后的价值.结果 CTO患者随访NYHA心功能变化,失访7例,最终纳入本研究53例患者,年龄36 ～70(57±11)岁,男50例、女3例.依据NYHA心功能分级,将心功能改善和无变化的患者定义为无进展组,将随访后心功能恶化的患者定义为进展组,发现两组患者之间年龄、冠心病高危因素及临床用药差异均无统计学意义.心功能无进展组患者的LVEF明显高于心功能进展组(42.3％±17.2％比22.2％±10.4％,P＜0.01).心功能进展组患者发生明显的左心室重构,ESV[(212±117)ml比(92±76) ml,P＜0.01]和EDV[(263±117)ml比(149 ±81)ml,P＜0.01]均明显大于心功能无进展组患者.以18 F-FDG PET/CT心肌葡萄糖代谢显像综合指标评价CTO病变患者的预后,敏感度(95.2％比75.7％)、特异度(62.8％比38.1％)和诊断符合率(90.2％比68.8％)均明显优于侧支循环形成对CTO患者NYHA心功能预后的评估.结论 18F-FDG PET/CT心肌葡萄糖代谢显像通过评估CTO病变心肌梗死部位存活、梗死心肌的范围、左心室整体收缩功能和心室重构参数,对于评估患者NYHA心功能的预后具有非常重要的价值.

abstractsObjective To evaluate the location,extent of viable myocardial of chronic total coronary occlusions(CTO)lesions by 18F-FDG PET myocardial metabolism imaging and then compare with coronary collateral circulation (CCC) to evaluate the prognostic evaluation in patients with CTO lesions.Methods A total of Sixty consecutive patients with CTO lesions referred for viability assessment from April 2016 to April 2017 in Department of Cardiology,Beijing Anzhen Hospital were included in the study.These patients underwent 99mTc-sestamibi ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated 18 FFDG PET/CT myocardial metabolic imaging,as well as coronary arteriography were recruited in this study.LV functional parameters(EDV,ESV,and LVEF) were analyzed by QGS software.The extent of CCC to the area of CTO related artery was graded as poorly,or well developed collaterals,assessed by Rentrop classification.All patients were followed up for a median of 17 months(range 12-20 months) and evaluated the changes of NYHA.Then the prognostic value of 18 F-FDG PET myocardial metabolism imaging and CCC in patients with CTO lesions were analyzed and evaluated.Results As the standard evaluation of NYHA in patients with CTO lesions after 12-20 months,fifty-three patients were assigned in this study.According to the changes of NYHA,the patients were divided into no progress group and progress group.There were no statistically difference in age,gender,high risk of CTO lesion and drugs in two groups,but there were significant statistical differences in myocardial parameters.LVEF was significantly increased in patients with CTO lesion in no progress group(42.3％ ± 17.2％ vs 22.2％ ± 10.4％,P ＜0.01).The EDV and ESV in no progress group were significantly smaller than patients in progress group.The sensitivity (95.2％ vs 75.7％) and specificity (62.8％ vs 38.1％) of 18F-FDG PET myocardial metabolism imaging was much better than CCC in the evaluation of prognosis in patients with CTO lesion.Conclusion 18 F-FDG PET myocardial metabolism imaging has important role in the prognosis of patient with CTO lesions when compared with CCC.