[扩张型心肌病患者治疗后心脏交感神经活动及心功能结局的预测：使用多巴酚丁胺门控心血池显像的检查]

[Prediction of cardiac sympathetic nerve activity and cardiac functional outcome after treatment in patients with dilated cardiomyopathy: examination using dobutamine gated blood pool scintigraphy].

作者信息

Kasama S, Toyama T, Hoshizaki H, Oshima S, Taniguchi K, Iwasaki T, Suzuki T, Nagai R

机构信息

Second Department of Internal Medicine, Gunma University School of Medicine.

出版信息

J Cardiol. 2000 Jul;36(1):29-35.

PMID:10929263

Abstract

OBJECTIVES

This study evaluated whether dobutamine gated blood pool scintigraphy can predict improvement of cardiac sympathetic nerve activity and cardiac function.

METHODS

Sixteen patients(10 men and 6 women, mean age 59 +/- 13 years) with dilated cardiomyopathy underwent dobutamine gated blood pool scintigraphy to measure left ventricular ejection fraction (LVEF) using tracer at 0, 5, 10 and 15 micrograms/kg/min before treatment. Patients were divided into good responders (LVEF increase > or = 15%) 8 patients(GR Group) and poor responders(LVEF increase < 15%) 8 patients (PR Group) after treatment with beta-blocker or amiodarone with a background treatment of digitalis, diuretics and angiotensin converting enzyme inhibitor. I-123 metaiodobenzylguanidine(MIBG) imaging to evaluate cardiac sympathetic nerve activity and echocardiography were performed before and at one year after treatment. MIBG imaging was obtained 4 hours after tracer injection, and the heart/mediastinum count ratio(H/M ratio) calculated from the anterior planar image and the total defect score(TDS) from the single photon emission computed tomography image. LVEF and left ventricular endo-diastolic dimension (LVDd) were measured by echocardiography and New York Heart Association(NYHA) functional class was evaluated.

RESULTS

The GR Group showed TDS decreased from 28 +/- 6 to 17 +/- 12(p < 0.05), H/M ratio increased from 1.79 +/- 0.26 to 2.07 +/- 0.32(p < 0.05), LVEF increased from 29 +/- 8% to 48 +/- 10%(p < 0.01), and LVDd decreased from 65 +/- 4 mm to 58 +/- 5 mm(p < 0.05). In contrast, the PR Group showed no significant changes in TDS, H/M ratio, LVEF and LVDd. NYHA functional class improved in both groups. The improvement was better in the GR Group than in the PR Group.

CONCLUSIONS

Dobutamine gated blood pool scintigraphy is useful to predict the improvement of the cardiac sympathetic nerve activity and cardiac function, and symptoms after treatment in patients with dilated cardiomyopathy.

摘要

目的

本研究评估多巴酚丁胺门控心血池显像是否能够预测心脏交感神经活动及心功能的改善情况。

方法

16例扩张型心肌病患者（10例男性，6例女性，平均年龄59±13岁）在治疗前接受多巴酚丁胺门控心血池显像，分别于0、5、10及15微克/千克/分钟剂量下使用示踪剂测量左心室射血分数（LVEF）。患者在接受洋地黄、利尿剂及血管紧张素转换酶抑制剂背景治疗的基础上，加用β受体阻滞剂或胺碘酮治疗后，分为反应良好组（LVEF增加≥15%）8例（GR组）和反应不佳组（LVEF增加<15%）8例（PR组）。在治疗前及治疗后1年进行I-123间碘苄胍（MIBG）显像以评估心脏交感神经活动，并进行超声心动图检查。在注射示踪剂4小时后获得MIBG显像，从前位平面图像计算心脏/纵隔计数比值（H/M比值），从单光子发射计算机断层扫描图像计算总缺损评分（TDS）。通过超声心动图测量LVEF及左心室舒张末期内径（LVDd），并评估纽约心脏协会（NYHA）心功能分级情况。

结果

GR组TDS从28±6降至17±12（p<0.05），H/M比值从1.79±0.26升至2.07±0.32（p<0.05），LVEF从29±8%升至48±10%（p<0.01），LVDd从65±4毫米降至58±5毫米（p<0.05）。相比之下，PR组TDS、H/M比值、LVEF及LVDd均无显著变化。两组NYHA心功能分级均有改善。GR组的改善情况优于PR组。