Otsuka M, Itagane H, Haze K
Department of Cardiology, Osaka City General Hospital.
J Cardiol. 1999 Feb;33(2):67-74.
The clinical significance of new fill-in observed by thallium-201 (201Tl) reinjection in myocardial segments with persistent defect in the subacute phase of myocardial infarction was investigated. Seventy-five patients with subacute phase (mean 20th day) of first myocardial infarction underwent stress-redistribution-reinjection 201Tl single photon emission computed tomography (SPECT) imaging. Percentage 201Tl uptake was calculated and classified as persistent defect without fill-in even after reinjection (PD group, n = 26, 35%), persistent defect with new fill-in after reinjection [REINJ (+) group, n = 19, 25%] and reversible defect [RD (+) group, n = 24, 32%]. The clinical features and angiographic findings were assessed in the same phase in each group. Diameter stenosis of the infarction-related arteries by coronary angiography was 68 +/- 34% in the PD group, 31 +/- 23% in the REINJ (+) group and 83 +/- 27% in the RD (+) group [p < 0.01, REINJ (+) group vs PD group and RD (+) group]. Wall motion of the infarcted myocardial segments significantly improved and the mean left ventricular ejection fraction (EF) was higher in the REINJ (+) group than in the PD group (mean EF 51% vs 43%, p < 0.01). Post infarction angina was more frequent in the RD (+) group than in the REINJ (+) group (38% vs 5%, p < 0.05). Although new fill-in-after 201Tl reinjection has been considered to indicate severe myocardial ischemia in chronic coronary disease, these results indicate that this phenomenon in viable myocardium in patients with subacute phase of myocardial infarction is not always related to residual ischemia in the infarcted myocardial area.
研究了在心肌梗死亚急性期心肌节段持续存在缺损的情况下，通过铊-201（201Tl）再注射观察到的新填充的临床意义。75例首次心肌梗死亚急性期（平均第20天）的患者接受了负荷-再分布-再注射201Tl单光子发射计算机断层扫描（SPECT）成像。计算201Tl摄取百分比，并将其分类为即使再注射后仍无填充的持续缺损（PD组，n = 26，35%）、再注射后有新填充的持续缺损[REINJ（+）组，n = 19，25%]和可逆缺损[RD（+）组，n = 24，32%]。对每组同一时期的临床特征和血管造影结果进行评估。冠状动脉造影显示，梗死相关动脉的直径狭窄在PD组为68±34%，在REINJ（+）组为31±23%，在RD（+）组为83±27%[p < 0.01，REINJ（+）组与PD组和RD（+）组相比]。REINJ（+）组梗死心肌节段的壁运动明显改善，平均左心室射血分数（EF）高于PD组（平均EF 51%对43%，p < 0.01）。RD（+）组梗死后心绞痛的发生率高于REINJ（+）组（38%对5%，p < 0.05）。尽管201Tl再注射后的新填充被认为表明慢性冠状动脉疾病存在严重心肌缺血，但这些结果表明，心肌梗死亚急性期患者存活心肌中的这种现象并不总是与梗死心肌区域的残余缺血相关。
