Emre A, Ersek B, Gürsürer M, Aksoy M, Siber T, Engin O, Yeşilçimen K
Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Clin Cardiol. 2000 Jul;23(7):495-500. doi: 10.1002/clc.4960230707.
Braunwald classification can be used as a measure of the acuteness or severity of clinical presentation of unstable angina. Gating perfusion images might provide additional information to that obtained from angiography, allowing correlations between the coronary anatomy and extent of myocardium at risk via simultaneous perfusion/function assessment.
The aim of this study was to determine the relation between the highest levels of the Braunwald classification (class III = rest angina within 48 h of presentation; class C = postinfarction angina; class c = refractory angina) and the angiographic findings, and the extent ofperfusion and segmental wall motion abnormalities using technetium-99m ((99m)Tc) sestamibi-gated single-photon emission computed tomography (SPECT) imaging.
The study group consisted of 86 patients with unstable angina who underwent rest gated (99m)Tc sestamibi SPECT imaging and coronary angiography. Perfusion was graded on a 5-point scale (0 = normal; 4 = absent uptake) and wall motion on a 4-point scale (0 = akinesia/dyskinesia; 3 = normal) using the 20 segment model. Perfusion (PI) and wall motion indices (WMI) were calculated by adding the score of all segments and dividing this by 20. The localization, the degree of stenosis, and the morphology of the culprit lesion were assessed. Multivariate analysis was performed to identify the independent predictors of class III, C, and c angina.
Perfusion index was higher and WMI was lower in classes III, C, and c than in classes < III, < C, and < c, respectively (all p < 0.001). Class III angina was associated with PI (p <0.0001), WMI (p< 0.0001), complex morphology (p = 0.01), and decreased Thrombolysis in Myocardial Infarction (TIMI) flow (p = 0.002); class C angina with PI (p < 0.0001), WMI (p< 0.0001), intracoronary thrombus (p = 0.007), and decreased TIMI flow (p = 0.003); and class c angina with PI (p = 0.005) and WMI (p = 0.006).
The highest levels of the Braunwald classification are associated with a greater size and intensity of myocardial perfusion and wall motion abnormalities and with the angiographic findings of complex morphology, intracoronary thrombus, and decreased TIMI flow.
Braunwald分类可用于衡量不稳定型心绞痛临床表现的急性程度或严重程度。门控灌注图像可能会提供一些血管造影所无法获得的额外信息，通过同步灌注/功能评估，可实现冠状动脉解剖结构与心肌危险范围之间的关联。
本研究旨在确定Braunwald分类的最高级别（III级=就诊后48小时内静息性心绞痛；C级=心肌梗死后心绞痛；c级=难治性心绞痛）与血管造影结果、使用锝-99m（99mTc）甲氧基异丁基异腈门控单光子发射计算机断层扫描（SPECT）成像所显示的灌注范围及节段性室壁运动异常之间的关系。
研究组由86例不稳定型心绞痛患者组成，这些患者均接受了静息门控99mTc甲氧基异丁基异腈SPECT成像及冠状动脉造影检查。采用20节段模型，灌注按五级评分（0=正常；4=无摄取），室壁运动按四级评分（0=运动减弱/运动障碍；3=正常）。灌注指数（PI）和室壁运动指数（WMI）通过将所有节段的评分相加并除以20来计算。评估罪犯病变的定位、狭窄程度及形态。进行多变量分析以确定III级、C级和c级心绞痛的独立预测因素。
III级、C级和c级的灌注指数分别高于<III级、<C级和<c级，而室壁运动指数则低于<III级、<C级和<c级（所有p<0.001）。III级心绞痛与PI（p<0.0001）、WMI（p<0.0001）、复杂形态（p=0.01）及心肌梗死溶栓（TIMI）血流降低（p=…0.002）相关；C级心绞痛与PI（p<0.0001）、WMI（p<0.0001）、冠状动脉内血栓（p=0.007）及TIMI血流降低（p=0.003）相关；c级心绞痛与PI（p=0.005）和WMI（p=0.006）相关。
Braunwald分类的最高级别与更大范围和强度的心肌灌注及室壁运动异常以及复杂形态、冠状动脉内血栓和TIMI血流降低的血管造影结果相关。
