Itoh Hideki, Namura Masanobu, Seki Hiroyuki, Asai Toru, Tsuchiya Taketsugu, Uenishi Hiroaki, Fujii Hiroyuki, Fujita Shinichirou, Tanabe Yujirou, Ito Jun, Shimizu Masami, Mabuchi Hiroshi
Department of Cardiology, Kanazawa Cardiovascular Hospital and Kanazawa University, Japan.
Circ J. 2002 Apr;66(4):341-4. doi: 10.1253/circj.66.341.
In areas of severe asynergy, the clinically important task is to identify functionally recoverable myocardium. Fourteen patients with asynergy were investigated by H2(15O) dynamic positron emission tomography imaging before revascularization. Regional myocardial blood flow (MBF) was determined and the water-perfusable tissue fraction (PTF) for each region of interest and the total anatomical tissue fraction (ATF) were estimated. The PTF/ATF was analyzed as the water perfusable tissue index (PTI). Asynergy was defined as segments with wall motion more than 2SD below than that of a normal population. An increase of >0.8SD in anterior wall segments with asynergy and an increase of >0.6 SD in inferior wall asynergy were defined as significant improvements of wall motion indicative of viable myocardium. Fifteen segments with wall motion abnormalities less than -2SD and 10 control segments were identified; 7 segments recovered and 8 segments did not. MBF was similar in both groups of segments before revascularization (0.78 +/- 0.27 vs 0.73 +/- 0.18 ml min-(-1) x g(-1), NS). The PTI in the recovered segments was significantly higher than that in the unimproved segments (0.734 +/- 0.058 vs 0.592 +/- 0.038, p<0.0001) and was similar to that of the control segments. After revascularization, the PTI correlated with the SD of wall motion (p<0.05, r=0.58). PTI may be a good predictor of contractile recovery after revascularization.
在严重运动不协调的区域，临床上的重要任务是识别功能可恢复的心肌。14例运动不协调患者在血运重建术前接受了H2(15O)动态正电子发射断层扫描成像检查。测定了局部心肌血流量(MBF)，并估算了每个感兴趣区域的水可灌注组织分数(PTF)和总解剖组织分数(ATF)。将PTF/ATF作为水可灌注组织指数(PTI)进行分析。运动不协调定义为壁运动比正常人群低2个标准差以上的节段。运动不协调的前壁节段增加>0.8个标准差，下壁运动不协调增加>0.6个标准差被定义为壁运动的显著改善，提示存活心肌。识别出15个壁运动异常小于-2个标准差的节段和10个对照节段；7个节段恢复，8个节段未恢复。血运重建术前两组节段的MBF相似(0.78±0.27 vs 0.73±0.18 ml min-(-1) x g(-1)，无显著性差异)。恢复节段的PTI显著高于未改善节段(0.734±0.058 vs 0.592±0.038，p<0.0001)，且与对照节段相似。血运重建后，PTI与壁运动标准差相关(p<0.05，r=0.58)。PTI可能是血运重建后收缩恢复的良好预测指标。
