| Objective: At present the methods of clinical diagnosis for myocardial ischemia are varied,the myocardial perfusion imaging has become recognized as the most accurate noninvasive examination method,however,as the concept of the fractional flow reserve is put forward and the application,make it possible to assessment of myocardial ischemia use invasive methods.In this study,through the comparison with myocardial fractional flow reserve,explore the clinical value of myocardial perfusion imaging in the evaluation of myocardial ischemia.Methods: From March 2014 to December 2015,a total of 89 in-hospital patients with unstable angina.Patients were eligible if they fulfilled the following inclusion criteria: According to the diagnostic criteria of Eighth edition of Internal Medicine:Formerly stable angina,increased frequency of pain episodes within a month,the degree of increaseed,extended the time limit,predisposing factors changed,nitric acid drugs relieve weakened;new onseted angina within a month,and induced by lighter load;onseted of angina at rest or induced by relatively minor activity.Exclusion criteria:the patients were confirmed by coronary angiography with one or multi-vessel occlusion;acute ST-segment elevation myocardial infarction;acute coronary syndrome with ST segment elevation,elevated myocardial enzymes and myocardial markers;old myocardial infarction;X syndrome;depressive and anxiety disorder;patients with serious hepatic,renal insufficiency and malignancy were excluded;patients with contrast agents and heparin allergy;patients with the contraindications of the myocardial perfusion imaging,coronary artery angiography and fractional flow reserve were excluded;patients were excluded with cardiac insufficiency and left ventricular ejection fraction<30%;cardiomyopathy and rheumatic heart disease;patients with a history of active bleeding recently;patients with asthma,chronic obstructive pulmonary disease;sick sinus syndrome,II,III degree atrioventricular block patients;patients with left bundle branch block must be ruled out.All the patients were given standard drug therapy of coronary heart disease,all selected patients with myocardial perfusion imaging(resting+movement)inspection,according to the result judgement may be at risk for myocardial ischemia in patients with lesions in blood vessels.Coronary angiography examination and fractional flow reserve measurement,according to the results of coronary angiography patients were divided into single coronary artery lesions and multivessel disease group.Application of quantitative coronary angiography analysis technology for coronary angiography results of quantitative analysis,by two experienced cardiac interventional physicians measure lesion blood vessel diameter and average rate of narrow,all stenosis>70% of the vessels measured fractional flow reserve,FFR?0.8 as there were no myocardial ischemia,FFR<0.8 were judged for myocardial ischemia,and suffered percutaneous coronary intervention.A detailed record of all the patients clinical basic information,such as patients' age,sex,hypertension,diabetes,heart ejection fraction,with or without smoking history,etc.In order to the results of FFR as the standard,to calculated the sensitivity,specificity and consistency of myocardial perfusion imaging to evaluate myocardial ischemia.Data processing of the experimental studies are used SPSS13.0 software for statistical and analysis,count data rate of data representation,statistical analysis using chi-square test,with P<0.05 was considered statistically significant difference.Results: Ultimately 89 patients completed the determination of myocardial perfusion imaging and fractional flow reserve.LAD lesions in 28 patients with single coronary artery lesions group,accounting for 43.75%,LCX lesions in 20 cases,accounted for 31.25%,RCA lesions in 16 cases,accounting for 25%,myocardial perfusion imaging was positive in 35 cases,29 cases negative;FFR positive in 30 cases,34 cases negative,in order to the results of FFR as the standard,the sensitivity,specificity consistency and KAPPA value of myocardial perfusion imaging to evaluate myocardial ischemia were 76.67%,64.71%,70.31%,0.410,and there were no significant difference between myocardial perfusion imaging and fractional flow reserve in the diagnosis of myocardial ischemia(P>0.05);25 patients were selected in multivessel disease group,a total of 65 lesions blood vessels,LAD lesions in 24 cases,accounted for 36.92%,LCX lesions in 21 cases,accounted for 32.30%,RCA lesions in 20 cases,accounting for 30.78%,myocardial perfusion imaging was positive in 35 cases,30 cases negative;FFR positive in 31 cases,34 cases negative,in order to the results of FFR as the standard,the sensitivity,specificity consistency and KAPPA value of myocardial perfusion imaging to evaluate myocardial ischemia were 83.87%,73.53%,78.46%,0.571,and there were no significant difference between myocardial perfusion imaging and fractional flow reserve in the diagnosis of myocardial ischemia(P>0.05).All the patients who FFR<0.80 received PCI therapy;the surgery achievement ratio reached 100%,coronary flow of disease lesion received TIMI grade 3,with no complication such as coronary perforation,acute stent thrombosis etc.And postoperative follow-up of six months,all did not have angina pectoris attack.Conclusion:1 Myocardial perfusion imaging in the evaluation of myocardial ischemia with coronary artery disease has a high degree of sensitivity,specific,there was a medium and high coincidence rate between the MPI and FFR,as a noninvasive test for patients who not willing or not suitable for fractional flow reserve provided a more reliable means of checking.2 In order to the results of FFR as the standard,the sensitivity and specificity of myocardial perfusion imaging to evaluate myocardial ischemia were increaseed with the increase of coronary lesion vessels.3 The revascularization is safe and feasible guided by FFR. |
PDF Full Text Request