Clinical Study Of Myocardial Perfusion Imaging And Coronary Angiography In The Diagnosis Of Ischemic Heart Disease

Aim: To explore the clinical application value of resting SPECT gated myocardial blood perfusion imaging and coronary angiography in the diagnosis of obstructive ischemic heart disease and coronary microcirculation dysfunction.Methods: Retrospectively collected in patients with chest pain suspected of ischemic heart disease or diagnosed with ischemic heart disease from June 2017 to October 2019 in Ningbo First Hospital,and selected all 99 m Tc-MIBI resting gated myocardial 223 patients with single photon emission computed tomography(SPECT)and selective coronary angiography(Coronary angiography CAG)were studied.CAG showed that coronary artery luminal area stenosis ≥50%was positive,coronary artery luminal area stenosis <50% was negative;resting SPECT myocardial ischemia was positive,and myocardial ischemia was not negative.Then analyze the results and perform statistical processing.Results: 1.Among all 223 patients,resting SPECT showed 132 cases of myocardial ischemia,and the positive rate of diagnosis of myocardial ischemia was 59.20%;CAG showed 87 cases of luminal area stenosis ≥50%,and the positive rate of coronary artery stenosis diagnosis was39.00%.The two examination methods have statistical significance for the diagnosis of ischemic heart disease(P<0.05).2.Among all 223 patients,56 cases of resting SPECT myocardial ischemia and CAG showed luminal area stenosis ≥50%;76 cases of 132 resting SPECT myocardial ischemia patients showed luminal area stenosis <50%;In 91 patients with resting SPECT myocardium without obvious ischemia,CAG showed 31 cases with luminal area stenosis ≥50%;of all 223 patients,60 cases with resting SPECT myocardium without obvious ischemia and luminal area stenosis <50%.The two examination methods are statistically significant(P<0.05).The positive rate of resting SPECT in the diagnosis of myocardial ischemia is higher.3.Taking the CAG luminal area stenosis ≥50% as the gold standard,in order to compare the consistency of the SPECT diagnostic standard and the gold standard,a Kappa test for consistency was performed.The consistency of the resting SPECT diagnostic standard and the CAG gold standard is poor(Kappa <0.4).The proportion of patients with luminal area stenosis <50% with myocardial ischemia and luminal area stenosis ≥50% with no myocardial ischemia increased.The sensitivity,specificity,positive predictive value,and negative predictive value of resting SPECT in the diagnosis of ischemic heart disease were 64.40%,44.10%,42.40%,and 65.90%,respectively.Conclusion: 1.CAG is the "gold standard" for the diagnosis of coronary heart disease,but the diagnosis of coronary microcirculation dysfunction may be missed.2.It is of great significance to choose SPECT myocardial perfusion examination in patients with chest pain to determine whether there is myocardial ischemia;especially before CAG examination,SPECT should be the "gatekeeper" of coronary angiography.3.The functional examination of SPECT myocardial perfusion imaging combined with the imaging examination of coronary angiography is indispensable for the diagnosis of coronary artery stenosis and coronary microcirculation dysfunction.It has an important complementary role and can improve coronary microcirculation dysfunction.The diagnostic positive rate has important clinical significance for guiding the treatment strategy selection of ischemic heart disease.