Gated Myocardial Perfusion Imaging Assessed Left Ventricular Systolic Function Of Old Myocardial Infarctioncompared With Real-time Three-dimensional Echocardiography

Objective:This-study-aims-to-use-ECG-gated-myocardial-perfusion-ima ging(G-SPECT) to observe left ventricular systolic function of old myocardial infarction(OMI), compared with full volume real time tree dimensional echocardiography(RT-3DE) and equilibrium radionuclide angiography(ERNA). Investigate G-SPECT and RT-3DE evaluating LV systolic function accurary and diffierence and correlation and clinical application in patients with OMI using this two methods.Methods:Screening in 33 cases with old myocardial infarction,divided into two groups.Group OMI Ⅰ have 12 cases with leftventricularejectionfraction(LVEF)aboving or equalling percent 50,group OMI Ⅱ have 11 cases with LVEF belowing percent 50 and aboving or equalling 30,group OMI Ⅲ have 10 cases with LVEF belowing percent 30.Besides 11 healthy adults were choosed as control.Exclusion criteria included acute and subacute stage of myocardial infarction.All cases were diagnosed and treatmented having not other cardiovascular disease and immune system disease.Cardiogenic shock on admission,severe left heart dysfuntion(Killip classification three or above),serious arrhythmia,severe hepatic and renal dysfunction,acute or chronic infection and malignant tumors cases were ruled out. 1 Gated Myocardial Perfusion Imaging(G-SPECT) and ERNA All cases that met the inclusion and exclusion criteria between December 2013 to February 2015,conventional nuclear medicine G-SPECT examination. Patients on an empty stomach in morning came with fat meals(fried eggs and 250 g milk).The patients elbow intravenous 925MBq~1110MBq 99mTc-MIBI after the completion of the imaging agent preparation,were told to eat the fatmeals after 30 mimutes.90 minutes later applied GE Discovery NM/CT670 SPECT/CT or GE infiniavc Hawkeye II SPECT/CT imaging device to do G-SPECT examination. In a week do the equilibrium radionuclide angiopraphy(ERNA) examination. According to nuclear medicine operation specification,the patients elbow intravenous stannous pyrophosphate(PYP,20ug/kg weight),30 minutes later elbow intravenous 740MBq~925MBq 99 mTc O4 eluent,and then applied GE Discovery NM/CT670 SPECT/CT or GE infiniavc Hawkeye II SPECT/CT imaging device to gather the images after 15 minutes. Conventional left anterior ovlique(LAO)35°planar imaging,matrix 64×64,zoom 1.5,gathered 600~800 beat. Images abtained post-processing by two experienced nuclear medicines physician,sketched the region of interesting(ROI),adjusted the angle of images,then we got left ventricular short-axis and vertical long-axis and level long-axis images.The two nuclear medicines applied semi-quantitative analysis left ventricular infarction myocardial.We choosed three short-axis images contained closing apex and middle ventricular and closing bottom of heart, and another middle ventricular vertical long-axis image to divided into 17 parts according to ACC/AHA/ASNC guiedline.Using 0 ~ 4points to assessment these 17 parts,0 point representative there no perfusion defect,2 points and 3 points representative little or middle perfusion defect,4 points representative sever perfusion defect or no perfusion.Through computer auto calculation we abtained left ventricular function parameters,left ventricular end diastolic volume(EDV),left ventricular end systolic volume(ESV),left ventricular ejection fraction(LVEF). 2 Real-time Three-dimensional Echocardiography(RT-3DE) Follow up all cases that met the inclusion and exclusion criteria G-SPECT examination in two weeks.Filed apex four-chamber view real time three dimensional dynamic images by using probe X5-1 of Philips IE33 color doppler ultrasonic apparatus,after latter analysis and processing,abtained left ventricular function parameters EDV,ESV and LVEF.Measured data conforms to normal distribution.Every group data were analyzed with paried-t tests and Pearson correlation analysis by using SPSS19.0 ststistical software,between groups using one-way anova analysis.Result: 1 General Information This study selected 33 patients.OMIⅠgroup whose LVEF≥55% have 12 cases,OMI Ⅱ group whose 30%≤LVEF < 50% have 11 cases,OMI Ⅲgrouphave 10 cases,the control group have 11 cases.All cases do not meet the conditions. 2 Left Ventricular Function Parameters 2.1 OMIⅠgroup EDV by G-SPECT and RT-3DE have no significant diffierences(t=-2.21,P > 0.05),compared with ERNA have no significant diffierences(for each t=2.01,-2.04,P>0.05).Pearson correlation analysis,EDV by G-SPECT and RT-3DE have good correlation,r=0.96,P<0.01,and have good correlation with ERNA,for each r=0.99, P<0.01. ESV by G-SPECT and RT-3DE have no significant diffierences(t=-0.33,P > 0.05), RT-3DE and ERNA have significant diffierences(t=-3.41,P <0.05),G-SPECT and ERNA have no significant diffierences(t=-1.51,P>0.05). Pearson correlation analysis,ESV by G-SPECT and RT-3DE have good correlation,r=0.97,P<0.01,and have good correlation with ERNA,r=0.96,0.99, P<0.01. LVEF by G-SPECT and RT-3DE have no significant diffierences(t=-1.85,P>0.05), have no significant diffierences with ERNA(for each t=-0.56,2.19, P>0.05). Pearson correlation analysis,LVEF by G-SPECT and RT-3DE have good correlation,r=0.88,P<0.01,and have good correlation with ERNA,for each r=0.93,0.98,P<0.01. 2.2 OMIⅡgroup EDV ESV and LVEF by G-SPECT and RT-3DE have no significant diffierences(for each t=0.78,1.56,-2.02, P > 0.05),and have no significant diffierences with ERNA(for each EDV t=-0.61,0.94,ESV t=-1.53,1.49,LVEFt=2.18,-1.29, P>0.05) Pearson correlation analysis,EDV by G-SPECT and RT-3DE have good correlation,r=0.88, P<0.01,and have good correlation with ERNA,for each r=0.96,0.97, P < 0.01.ESV by G-SPECT and RT-3DE have good correlation,r=0.85, P<0.01,and have good correlation with ERNA,for each r=0.95,0.96, P < 0.01.LVEF by G-SPECT and RT-3DE have good correlation,r=0.63, P<0.05,and have good correlation with ERNA,for each r=0.93,0.83, P<0.01. 2.3 OMI Ⅲ group EDV by G-SPECT and RT-3DE have significant diffierences(t=-3.00, P<0.05),and have no significant diffierences with ERNA(for each t=2.01,-1.47, P>0.05). Pearson correlation analysis,EDV by G-SPECT and RT-3DE have good correlation,r=0.76, P<0.05, and have good correlation with ERNA,for each r=0.83,0.86, P<0.01. ESV by G-SPECT and RT-3DE have no significant diffierences(t=-1.21, P > 0.05),and have no significant diffierences with ERNA(for each t=1.51,0.21, P>0.05). Pearson correlation analysis,ESV by G-SPECT and RT-3DE have good correlation,r=0.80, P<0.05, and have good correlation with ERNA,for each r=0.82,0.88, P<0.01. LVEF by G-SPECT and RT-3DE have significant diffierences(t=-4.90, P<0.05),and G-SPECT have no significant diffierences with ERNA( t=-4.92, P>0.05),RT-3DE have significant diffierences with ERNA(t=-4.78, P<0.05). Pearson correlation analysis,LVEF by G-SPECT and RT-3DE have general correlation,r=0.63, P<0.01, and have general correlation with ERNA,for each r=0.78,0.56, P<0.01. 2.4 The control group EDV ESV LVEF by G-SPECT and RT-3DE have no significant diffierences(for each t=0.81,2.16,-1,91, P > 0.05),and have no significant diffierences with ERNA(for each EDV t=-0.66,0.83,ESV t=-1.44,2.05,LVEF t=0.48,-1.79,P > 0.05). Pearson correlation analysis, all paramerers by G-SPECT and RT-3DE have good correlation,for each EDV r=0.94,ESVr=0.95,LVEF r=0.80,P < 0.01,and have 与 GBPI good correlation with ERNA,for each EDV r=0.98,0.97,ESV r=0.99,0.98,LVEF r=0.90,0.88,P <0.01.Conclusions: 1 G-SPECT and RT-3DE both can accurately measure left ventricular ejection fraction. 2 OMI even who left ventricular systolic function decreased seriously,should choose G-SPECT to assessment their left ventricular funtion.