Mannting F, Zabrodina Y V, Dass C
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02155, USA.
J Nucl Med. 1999 Jun;40(6):889-94.
The significance of increased right ventricular (RV) tracer uptake in patients with coronary artery disease (CAD) without pulmonary or valvular heart disease is unclear.
Forty consecutive patients with increased RV uptake on SPECT myocardial perfusion imaging and right heart catheterization within 4 wk were studied prospectively. Thirty-five individuals with very low likelihood of CAD served as controls. Rest and stress SPECT myocardial perfusion data were obtained using a standard 99mTc-sestamibi 1-d imaging protocol. A quick and simple RV-to-left ventricular (LV) myocardial uptake ratio was calculated from the maximum counts per pixel detected in the right and left ventricles using the reconstructed coronal slices. RV end-systolic pressure (RV-ESP), mean pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure were obtained by standard techniques.
The RV/LV uptake ratio in the controls was 0.31+/-0.05. Thirty-six of the 40 (90%) CAD patients with increased RV tracer uptake had increased RV-ESP, and 39 (97.5%) had increased PAP. Highly significant positive correlations between the RV/LV uptake ratio and RV-ESP and PAP were found (r = 0.45, P = 0.003; and r = 0.52, P < 0.001, respectively).
Increased RV uptake, assessed from standard myocardial perfusion studies, can identify RV pressure overload among patients with CAD. In the absence of pulmonary or valvular heart disease, increased RV uptake (i.e., RV pressure overload) indicates significant backward failure, a variable with known significant negative prognostic implications.
在没有肺部或瓣膜性心脏病的冠状动脉疾病（CAD）患者中，右心室（RV）示踪剂摄取增加的意义尚不清楚。
对连续40例在4周内进行单光子发射计算机断层扫描（SPECT）心肌灌注显像时右心室摄取增加且接受右心导管检查的患者进行前瞻性研究。35例CAD可能性极低的个体作为对照。使用标准的99m锝-甲氧基异丁基异腈1日成像方案获取静息和负荷SPECT心肌灌注数据。使用重建的冠状切片，根据在右心室和左心室中检测到的每像素最大计数计算快速简单的右心室与左心室（LV）心肌摄取比值。通过标准技术获得右心室收缩末期压力（RV-ESP）、平均肺动脉压（PAP）和肺毛细血管楔压。
对照组的右心室/左心室摄取比值为0.31±0.05。40例右心室示踪剂摄取增加的CAD患者中，36例（90%）的RV-ESP升高，39例（97.5%）的PAP升高。发现右心室/左心室摄取比值与RV-ESP和PAP之间存在高度显著的正相关（r = 0.45，P = 0.003；r = 0.52，P < 0.001）。
从标准心肌灌注研究评估的右心室摄取增加可识别CAD患者中的右心室压力过载。在没有肺部或瓣膜性心脏病的情况下，右心室摄取增加（即右心室压力过载）表明存在明显的逆向衰竭，这是一个具有已知显著负面预后意义的变量。
