Hassan Nathalie, Escanyé Jean-Marie, Juillière Yves, Marie Pierre-Yves, David Nicolas, Olivier Pierre, Ayalew Adey, Karcher Gilles, Stolz Jean-François, Bertrand Alain
Department of Nuclear Medicine, Unité Propre de Recherche de l'Enseignement Superieur-Equipe d'Accueil 3447, Centre Hospitalier Universitaire, Nancy, France.
J Nucl Med. 2002 Apr;43(4):451-7.
This study was aimed at determining whether the (201)Tl SPECT abnormalities documented in patients with dilated cardiomyopathy are related to a local excess in wall stress, which might act against the diastolic perfusion of myocardium.
We included 6 healthy volunteers and 7 patients with idiopathic dilated cardiomyopathy who underwent (201)Tl SPECT at rest. On a 13-segment division of the left ventricle, indices of wall stress and tension were calculated at end-diastole by applying Laplace's law, with thickness and curvature radii being determined for each segment on 2 orthogonal MRI slices.
Among all patients, 21 analyzed segments had (201)Tl SPECT defects (D+) and 67 had none (D-). Myocardial thickness was lower in D+ (0.88 +/- 0.30 cm) than in D- (1.23 +/- 0.33 cm, P = 0.0002) or in segments from healthy volunteers (0.99 +/- 0.15 cm, P = 0.04). The index of end-diastolic wall tension was also lower in D+ (2.5 +/- 1.0 N.m(-1).mm Hg(-1)) than in D- (3.3 +/- 1.1 N.m(-1).mm Hg(-1), P = 0.02) or in segments from healthy volunteers (3.2 +/- 1.2 .m(-1).mm Hg(-1)) P = 0.04). Last, the index of end-diastolic wall stress, determined by the ratio of wall tension index to myocardial thickness, was equivalent in D+, in D-, and in segments from healthy volunteers (respectively, 3.0 +/- 1.4, 2.8 +/- 1.2, and 3.2 +/- 1.6 hN.m(-2).mm Hg(-1)).
In patients with dilated cardiomyopathy, the abnormalities documented by (201)Tl SPECT at rest are related to a lower than normal wall thickness and not to an excess in wall stress or tension. Therefore, partial-volume effects are likely to induce these abnormalities, and they may be unrelated to any insufficiency of myocardial perfusion.
本研究旨在确定扩张型心肌病患者中记录的（201）铊单光子发射计算机断层扫描（SPECT）异常是否与局部壁应力过高有关，而壁应力过高可能会影响心肌的舒张期灌注。
我们纳入了6名健康志愿者和7名特发性扩张型心肌病患者，他们在静息状态下接受了（201）铊SPECT检查。在左心室的13段划分中，通过应用拉普拉斯定律在舒张末期计算壁应力和张力指数，其中厚度和曲率半径通过2个正交的磁共振成像（MRI）切片上的每个节段来确定。
在所有患者中，21个分析节段有（201）铊SPECT缺陷（D +），67个节段无缺陷（D -）。D +节段的心肌厚度（0.88±0.30厘米）低于D -节段（1.23±0.33厘米，P = 0.0002）或健康志愿者节段（0.99±0.15厘米，P = 0.04）。舒张末期壁张力指数在D +节段（2.5±1.0牛顿·米-1·毫米汞柱-1）也低于D -节段（3.3±1.1牛顿·米-1·毫米汞柱-1，P = 0.02）或健康志愿者节段（3.2±1.2牛顿·米-1·毫米汞柱-1，P = 0.04）。最后，由壁张力指数与心肌厚度之比确定的舒张末期壁应力指数在D +节段、D -节段和健康志愿者节段中相当（分别为3.0±1.4、2.8±1.2和3.2±1.6毫牛顿·米-2·毫米汞柱-1）。
在扩张型心肌病患者中，静息状态下（201）铊SPECT记录的异常与低于正常的壁厚度有关，而与壁应力或张力过高无关。因此，部分容积效应可能会诱发这些异常，并且它们可能与心肌灌注不足无关。
