Prevalence of Decreased Myocardial Blood Flow in Symptomatic Patients with Patent Coronary Stents: Insights from Low-Dose Dynamic CT Myocardial Perfusion Imaging
Prevalence of Decreased Myocardial Blood Flow in Symptomatic Patients with Patent Coronary Stents: Insights from Low-Dose Dynamic CT Myocardial Perfusion Imaging
复制标题
有症状的冠状动脉支架植入患者中心肌血流量减少的普遍性：低剂量动态 CT 心肌灌注成像的见解
DOI：
10.3348/kjr.2018.0399
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发表时间：
2019-04-01
影响因子：
4.8
通讯作者：
Zhang, Jiayin
中科院分区：
文献类型：
--
作者：
Li, Yuehua;Yuan, Mingyuan;Zhang, Jiayin
目的探讨无支架内再狭窄症状性患者动态CT心肌灌注成像(MPI)定量心肌血流量(MBF)减少的发生率和临床特点。材料与方法采用第三代双源CT扫描仪对37例有症状的冠状动脉支架未闭患者进行动态CT-MPI检查，年龄48~88岁，平均71.3±10岁，男31例，女6例。采用穿梭模式采集技术对完整的左心室进行成像。造影剂50mL，碘普罗胺，370mgI/mL，以6mL/S的速度注入肘前静脉，然后用40mL生理盐水冲洗。测量每段支架内血管区域和参考区域的平均MBF值和其他定量参数。MBF比率定义为整个支架-血管区域的平均MBF值与整个参考区的平均MBF值的比率。以MBF比率0.85为分界值，区分低血流灌注节段与非低血流灌注节段。结果37例患者的629个节段最终纳入分析。动态CT-MPI有效剂量1.7~6.3mSv，平均3.1±1.2mSv。19个病变81个节段支架-血管区域的平均MBF降低。与非低灌注组比较，低灌注组的平均心肌血流量和心肌血容量显著降低(分别为77.5±16.6mL/100mLvs.140.4±24.1mLvs.140.4±24.1mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mLvs.11.5±4mL.[p<；0.001])。48.6%(18/37)的患者存在支架-血管区域的心肌低灌注率。低灌注组和非低灌注亚组之间的临床参数无统计学差异。结论经皮冠状动脉介入治疗后有症状的患者，尽管支架未通，但MBF降低是常见的，可通过低辐射剂量的动态CT-MPI检测到。
Objective To study the prevalence and clinical characteristics of decreased myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) in symptomatic patients without in-stent restenosis. Materials and Methods Thirty-seven (mean age, 71.3 ± 10 years; age range, 48–88 years; 31 males, 6 females) consecutive symptomatic patients with patent coronary stents and without obstructive de novo lesions were prospectively enrolled to undergo dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used to image the complete left ventricle. A bolus of contrast media (50 mL; iopromide, 370 mg iodine/mL) was injected into the antecubital vein at a rate of 6 mL/s, followed by a 40-mL saline flush. The mean MBF value and other quantitative parameters were measured for each segment of both stented-vessel territories and reference territories. The MBFratio was defined as the ratio of the mean MBF value of the whole stent-vessel territory to that of the whole reference territory. An MBFratio of 0.85 was used as the cut-off value to distinguish hypoperfused from non-hypoperfused segments. Results A total of 629 segments of 37 patients were ultimately included for analysis. The mean effective dose of dynamic CT-MPI was 3.1 ± 1.2 mSv (range, 1.7–6.3 mSv). The mean MBF of stent-vessel territories was decreased in 19 lesions and 81 segments. Compared to stent-vessel territories without hypoperfusion, the mean MBF and myocardial blood volume were markedly lower in hypoperfused stent-vessel territories (77.5 ± 16.6 mL/100 mL/min vs. 140.4 ± 24.1 mL/100 mL/min [p < 0.001] and 6.4 ± 3.7 mL/100 mL vs. 11.5 ± 4 mL/100 mL [p < 0.001, respectively]). Myocardial hypoperfusion in stent-vessel territories was present in 48.6% (18/37) of patients. None of clinical parameters differed statistically significantly between hypoperfusion and non-hypoperfusion subgroups. Conclusion Decreased MBF is commonly present in patients who are symptomatic after percutaneous coronary intervention, despite patent stents and can be detected by dynamic CT-MPI using a low radiation dose.