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目的确定静息态下透壁心肌灌注指数(TPR)的正常值,并探讨静息态下不同分支的冠状动脉狭窄与各冠状动脉分支的不同狭窄程度对左室壁不同节段TPR的影响。方法 274例患者行Toshiba 640层CT检查,包括冠状动脉CTA及左心室室壁CT灌注(CTP)检查。根据冠状动脉狭窄程度及17节段进行分组。计算正常组及不同冠状动脉狭窄程度组之间相应节段内TPR是否存在差异,以及冠状动脉狭窄程度与相应节段TPR的相关性。结果前降支及左旋支病变对于左室壁心肌灌注影响较为明显,前降支狭窄主要影响中间段前壁(r=-0.288)、心尖段前壁(r=-0.263)及中间段间隔壁(r=-0.196),左旋支主要影响基底部前侧壁(r=-0.241)、基底部后侧壁(r=-0.279)及心尖段侧壁(r=-0.201),而右冠状动脉病变影响较小,主要影响中间段后壁(r=-0.195);冠状动脉中、重度狭窄组对于左室壁心肌灌注影响程度较大(P<0.05),轻度狭窄影响较小;左室前壁心肌灌注最易受到冠状动脉狭窄影响;在静息状态下前降支供血区域组、左旋支供血区域组及右冠状动脉供血区域组正常心肌和重度狭窄心肌平均TPR值分别为1.14±0.09和1.07±0.13、1.13±0.11和1.06±0.14、1.15±0.14和1.10±0.12。结论不同冠状动脉分支狭窄分别可以影响不同节段的心肌透壁灌注;不同冠状动脉狭窄程度可以不同程度地影响心肌的TPR,二者具有相关性;静息状态下TPR正常值大于负荷状态下TPR。本研究提供了TPR静息态下的正常值。
Objective To determine the normal value of transmyocardial perfusion index (TPR) at resting state and to investigate the effect of stenosis of different branches and different degree of stenosis of coronary artery branches on resting TPR in different segments of left ventricular wall. Methods 274 patients underwent Toshiba 640-slice CT examination, including coronary CTA and left ventricular wall CT perfusion (CTP) examination. According to the degree of coronary artery stenosis and 17 segments were grouped. The difference of TPR in the corresponding segment between the normal group and different groups of coronary artery stenosis was calculated and the correlation between the degree of coronary artery stenosis and the corresponding segment TPR was calculated. Results The anterior descending coronary artery and left circumflex artery lesion had a significant effect on left ventricular myocardial perfusion. The anterior descending coronary artery stenosis mainly affected the anterior segment of the middle segment (r = -0.288), the anterior segment of the apical segment (r = -0.263) (r = -0.196). The left circumflex artery mainly affected the basal anterior wall (r = -0.241), basal posterior wall (r = -0.279) and apical segment wall (r = -0.201) (R = -0.195). Coronary artery stenosis group had a greater influence on left ventricular wall myocardial perfusion (P <0.05), and mild stenosis had less effect. Left ventricular The anterior myocardial perfusion was the most vulnerable to coronary artery stenosis. The mean TPR of normal myocardium and severe stenosis myocardium in the anterior descending coronary artery, left circumflex artery and right coronary artery were 1.14 ± 0.09 And 1.07 ± 0.13, 1.13 ± 0.11 and 1.06 ± 0.14, 1.15 ± 0.14 and 1.10 ± 0.12, respectively. Conclusions Different stenosis of coronary artery branches can affect myocardial transmural perfusion in different segments. The degree of coronary stenosis can affect the myocardial TPR to some extent. The resting TPR normal value is higher than the TPR . This study provides normal values for resting TPR.