【摘要】 目的探讨99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层扫描(SPECT)运动负荷试验评价卡维地洛对老年缺血性心肌病患者左室功能的影响。方法经冠状动脉造影术(coronary angiography,CAG)和二维心脏超声诊断为缺血性心肌病的老年患者50例随机分两组,卡维地洛组(口服卡维地洛37.5mg/d)26例,平均年龄(67±7)岁。安慰剂组24例,平均年龄(69±10)岁,治疗前后进行99mTc-MIBI运动负荷试验。结果6个月后随访,运动负荷试验257段室壁运动改善的有182段,占70.8%,多为运动减弱、运动消失的心肌组织(51.8%,18.7%)(P=0.013)。卡维地洛组患者的左室射血分数(LVEF)增加,左室舒末容积(LVEDV)和左室缩末容积(LVESV)减少(P=0.002)。左室舒末容积指数(LVEDVI)和左室缩末容积指数(LVESVI)减少(P=0.001);而安慰剂组患者没有显著变化(P=0.211)。卡维地洛组患者冠脉狭窄程度没有改变但平均侧支积分增加(0.85±0.7,2.5±0.8,P=0.025);安慰剂组平均侧支积分没有显著变化(0.93±0.72,0.84±0.76,P=0.082)。相关分析表明侧支循环越丰富,99mTc-MIBI运动负荷试验室壁运动积分越低,左心室功能改善越明显(r=-0.73;P=0.023)。结论卡维地洛可以改善缺血性心肌病患者的室壁运动,提高左室功能,可能有增加侧支循环的作用,适合用于治疗老年缺血性心肌病患者。更多还原

【Abstract】 Objective To evaluate the effects of Carvedilol on left ventricular function in old patients with ischemic cardiomyopathy using 99mTc-MIBI exercise stress test.Methods Fifty patients with ischemic cardiomyopathy proved with coronary angiography (CAG) and two-dimensional echocardiography were recruited and randomly assigned into Carvedilol group (with averaged age 67±7 years old) and control group (with averaged age 69±10years old).The 99mTc-MIBI exercise stress test was performed before and after treatment to assess left ventricular function.Results Significant improvement of ventricular wall motion were found in Carvedilol group using 99mTc-MIBI Exercise Stress test after six months of follow-up (P=0.013).Improvements of wall motion were noticed in 182 out of 257 segments (about 72.2 percent),mainly including motion weakening or disappearing heart tissues (51.8%,18.7%) in Carvedilol group.Carvedilol significantly increased left ventricular eject fraction (LVEF) and reduced left ventricular end-diastolic volumes (LVEDV),left ventricular end–systolic volumes(LVESV),left ventricular end-diastolic volumes index (LVEDVI) and left ventricular end–systolic volumes index (LVESVI),while there was no significant change found in the control group (P=0.211).Although Carvedilol treatment showed no relief on coronary stenosis,it improved the collateral branch scores significantly (0.85±0.7,2.5±0.8,P=0.025).No significant improvement (0.93±0.72,0.84±0.76,P=0.082) was found in the control group.There was a negative correlation between the collateral branch score and the wall motion scores in 99mTc-MIBI Exercise Stress and a positive correlation with improvement of cardiac function (r=-0.73,P=0.023) after treatment.Conclusion Carvedilol might improve ventricular wall motion,increase left ventricular function and collateral branch circulation and can be used in old patients with serious ischemic cardiomyopathy.更多还原