Vị trí kích hoạt cơ học muộn nhất được đánh giá qua chụp SPECT tưới máu cơ tim ở bệnh nhân thiếu máu cơ tim và giãn cơ tim với tắc nhánh bó trái

European Journal of Nuclear Medicine - Tập 41 - Trang 1232-1239 - 2014
Xianhe Lin1, Huiqin Xu2, Xuefeng Zhao2, Ji Chen3
1Department of Cardiology, Anhui Medical University, Hefei, China
2Department of Nuclear Medicine, Anhui Medical University, Hefei, China
3Department of Radiology and Imaging Sciences, Emory University, Atlanta, USA

Tóm tắt

Các vị trí kích hoạt cơ học muộn nhất (SOLA) đã được công nhận là những vị trí dẫn truyền thất trái (LV) tối ưu cho liệu pháp đồng bộ tim mạch (CRT). Nghiên cứu này nhằm điều tra SOLA ở bệnh nhân thiếu máu cơ tim (ICM) và bệnh giãn cơ tim (DCM) có tắc nhánh bó trái (LBBB). Sáu mươi bốn bệnh nhân LBBB liên tiếp (47 DCM, 17 ICM), đáp ứng tiêu chí tiêu chuẩn cho CRT và trải qua chụp hình tưới máu cơ tim bằng SPECT (MPI) trong trạng thái nghỉ đã được lựa chọn. Phân tích pha được sử dụng để đánh giá sự không đồng bộ LV và SOLA. Bộ công cụ tim mạch Emory được sử dụng để đo các khuyết tật tưới máu. Sự không đồng bộ LV và SOLA đã được so sánh giữa các bệnh nhân DCM với thời gian QRS kéo dài (≥150 ms) và trung bình (120-150 ms). Mối quan hệ giữa SOLA và khuyết tật tưới máu được phân tích ở các bệnh nhân ICM. Các bệnh nhân DCM với QRS kéo dài có sự không đồng bộ LV đáng kể hơn so với những người có QRS trung bình. Các vị trí SOLA bên bên được ghi nhận thường xuyên hơn ở các bệnh nhân DCM có QRS kéo dài so với những người có QRS trung bình (96% so với 62%, p = 0.010). Ở bệnh nhân ICM, SOLA nằm trong các đoạn sẹo (82%) hoặc trong các đoạn liền kề với các đoạn sẹo (18%), không phụ thuộc vào QRS. Các vị trí SOLA bên bên xuất hiện nhiều hơn ở các bệnh nhân DCM có QRS kéo dài so với các bệnh nhân có QRS trung bình. Mối quan hệ này không được quan sát thấy ở các bệnh nhân ICM, nơi mà SOLA liên quan đến vị trí sẹo hơn là QRS. Những phát hiện này hỗ trợ việc sử dụng chụp SPECT MPI để hỗ trợ việc lựa chọn các đối tượng có khả năng phản ứng với CRT và hướng dẫn đặt dẫn truyền LV.

Từ khóa

#SOLA #LBBB #ICM #DCM #CRT #chụp SPECT tưới máu cơ tim

Tài liệu tham khảo

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