Взаимосвязь дооперационных показателей перфузионной сцинтиграфии миокарда и флоуметрии маммарокоронарных шунтов у больных с ишемической кардиомиопатией

Цель исследования: определение связи между предоперационными показателями перфузии миокарда по данным ОФЭКТ (ПСМ) и характеристиками кровотока по маммарокоронарным шунтам (МКШ) по данным интраоперационной флоуметрии у пациентов с ишемической кардиомиопатией (ИКМП).

Материал и методы. В исследование вошло 57 больных с ИКМП. Всем пациентам была выполнена предоперационная ПСМ с ^99mTc-MIBI и интраоперационная флоуметрия кровотока по МКШ. Вычислялись следующие численные показатели флоуметрии: объемная скорость кровотока (Q), индекс сопротивления (PI), и диастолическое наполнение (DF). Проходимость анастомоза считалась удовлетворительной при нормальной форме флоуметрической волны, диастолически-доминантном кровенаполнении и значении Q более 11,5 мл/мин.

Результаты. Пациенты были разделены на 2 группы: с удовлетворительной (n = 40) и неудовлетворительной (n = 17) проходимостью шунта по данным интраоперационной флоуметрии. По данным ПСМ различия между группами были выявлены в показателях перфузии покоя (summed rest score, SRS) – 20,7 ± 7,5% и 29,8 ± 4,0%; p = 0,002, общего дефицита перфузии (total perfusion deficit, TPD) в покое – 32,0 ± 11,4 и 43,0 ± 7,2; p = 0,01 и TPD в покое на территории передней нисходящей артерии – 20,7 ± 7,5 и 29,8 ± 4,0; р = 0,002. Кроме того, показатели флоуметрии различались у пациентов с хирургической реконструкцией левого желудочка и без нее (Q: 17 (11,5, 40,8) и 47 (25, 69,5) мл/мин, p = 0,013; PI: 3,9 (3,2, 7,4) и 2,4 (2,0, 3,6), p = 0,001, DF: 63,5 (44,5, 70,8) и 74 (66,0, 79,7)%, p = 0,019). TPD в покое, равный 26,85, был лучшим предиктором удовлетворительного состояния шунта (AUC = 0,771, чувствительность 83,3%, специфичность 78,1%).

Заключение. Предоперационные характеристики перфузии миокарда ассоциированы с показателями кровотока по МКШ у пациентов с ишемической кардиомиопатией. TPD в покое и SRS могут являться потенциальными предикторами ранней недостаточности шунта.

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