Boff G M, Zanco P, Della Valentina P, Cardaioli P, Thiene G, Chioin R, Dalla Volta S
Department of Cardiology. University Medical School of Paduca, Padova, Italy.
Int J Cardiol. 2000 Jun 12;74(1):67-74; discussion 75-6. doi: 10.1016/s0167-5273(00)00245-x.
We evaluated the utility of positron emission tomography in differentiating patients with idiopathic dilated cardiomyopathy from those with ischemic cardiomyopathy. Twenty consecutive non-diabetic patients with dilatation (end-diastolic volume > or = 120 cc/m2) and reduced systolic function (ejection fraction < or = 40%) of the left ventricle on cineangiography, underwent coronary angiography, F18 fluorodeoxyglucose (F18-FDG) (glucose load technique) and N13-ammonia (N13-NH3) positron emission tomography. A semiquantitative score based on the extension and the severity of the uptake defects was calculated. Endomyocardial biopsy was performed in patients with normal coronary arteries. Ten patients (group A) had normal coronary arteries and histologic features of the endomyocardium fitting with the diagnosis of idiopathic dilated cardiomyopathy. Cineangiography showed critical stenosis of at least one major coronary artery in the other 10 patients (group B). The two groups were similar in age. left ventricular end-diastolic volume and ejection fraction. Both N13-NH3, positron emission tomography and F18-FDG positron emission tomography scores were lower in group A than in group B: 0.1 +/- 0.3 vs. 10.6 +/- 5.1 (P<0.0001) and 2.4 +/- 4.4 vs. 9.9 +/- 4.1 (P<0.0001) respectively. but only N13-NH3 positron emission tomography allowed a complete separation of the two groups (score range 0-1 group A vs. 4-12 group B). The F18-FDG score value showed some overlapping between the two groups (score range 0-12 in the group A vs. 2-17 in the group B). All three idiopathic dilated cardiomyopathy patients with a F18-FDG score value >2 had left bundle branch block on standard ECG. Positron emission tomography imaging with N13-NH3 and F18-FDG provided a complete differentiation between idiopathic dilated cardiomyopathy and ischemic cardiomyopathy patients. However patients with left bundle branch block on ECG could present defects in FDG uptake even if affected by idiopathic dilated cardiomyopathy.
我们评估了正电子发射断层扫描在鉴别特发性扩张型心肌病患者与缺血性心肌病患者方面的效用。连续20例非糖尿病患者，其心脏造影显示左心室扩张（舒张末期容积≥120 cc/m²）且收缩功能降低（射血分数≤40%），这些患者接受了冠状动脉造影、F18氟脱氧葡萄糖（F18 - FDG）（葡萄糖负荷技术）和N13 - 氨（N13 - NH3）正电子发射断层扫描。基于摄取缺陷的范围和严重程度计算了一个半定量评分。冠状动脉正常的患者进行了心内膜活检。10例患者（A组）冠状动脉正常，心内膜组织学特征符合特发性扩张型心肌病的诊断。另外10例患者（B组）心脏造影显示至少一支主要冠状动脉存在严重狭窄。两组患者在年龄、左心室舒张末期容积和射血分数方面相似。A组的N13 - NH3正电子发射断层扫描评分和F18 - FDG正电子发射断层扫描评分均低于B组：分别为0.1±0.3 vs. 10.6±5.1（P<0.0001）和2.4±4.4 vs. 9.9±4.1（P<0.0001），但只有N13 - NH3正电子发射断层扫描能够完全区分两组（A组评分范围0 - 1，B组评分范围4 - 12）。F18 - FDG评分值在两组之间存在一些重叠（A组评分范围0 - 12，B组评分范围2 - 17）。所有F18 - FDG评分值>2的3例特发性扩张型心肌病患者在标准心电图上均有左束支传导阻滞。N13 - NH3和F18 - FDG正电子发射断层扫描成像能够完全区分特发性扩张型心肌病患者和缺血性心肌病患者。然而，心电图上有左束支传导阻滞的患者即使患有特发性扩张型心肌病，也可能出现FDG摄取缺陷。
