Sanders Gregory P, Pinto Duane S, Parker J Anthony, Koutkia Polyxeni, Aepfelbacher Franz C, Danias Peter G
Cardiovascular Division, Department of Medicine, and Boston University School of Medicine, Boston, Mass 02215, USA.
J Nucl Cardiol. 2003 Mar-Apr;10(2):140-7. doi: 10.1067/mnc.2003.399.
Stress lung thallium 201 uptake correlates with left ventricular (LV) dysfunction and extent of coronary artery disease (CAD). Although Tl-201 is used less commonly for stress imaging, dual-isotope stress and viability protocols continue to use Tl-201 for rest imaging. We sought to investigate the association between increased resting Tl-201 lung-to-heart ratio (LHR) and hemodynamic indices of LV dysfunction, indices of myocardial perfusion, and extent of CAD.
Over a 1-year period, we identified 192 consecutive patients who underwent dual-isotope stress perfusion imaging and cardiac catheterization within 30 days, without interim events or revascularization. Resting LHR was measured, and its association with invasively measured hemodynamic parameters, extent of CAD, and indices of myocardial perfusion at rest and stress was examined. Increased resting Tl-201 LHR was weakly but significantly associated with lower LV ejection fraction (EF) (r = 0.209, P <.05), higher pulmonary capillary wedge pressure (r = 0.25, P <.005), and LV end-diastolic pressure (r = 0.215, P <.01) but not with pulmonary artery systolic pressure. Increased LHR was also weakly associated with rest perfusion abnormalities including the sum rest score (r = 0.271, P <.001) and number of abnormally perfused segments (r = 0.25, P <.001) bud did not correlate with stress perfusion indices or ischemic burden. The 76 patients (40%) with LHR greater than 0.5 were more likely to have LVEF lower than 40% and 3-vessel/left main CAD.
Increased rest Tl-201 LHR is weakly associated with higher LV end-diastolic pressure and pulmonary capillary wedge pressure and lower LVEF. LHR is also associated with the extent of previously infarcted myocardium and may indicate the presence of 3-vessel/left main CAD.
应激状态下肺对铊-201的摄取与左心室（LV）功能障碍及冠状动脉疾病（CAD）的范围相关。尽管铊-201较少用于应激成像，但双同位素应激及存活心肌检查方案仍继续使用铊-201进行静息成像。我们试图研究静息铊-201肺心比（LHR）升高与左心室功能障碍的血流动力学指标、心肌灌注指标及冠状动脉疾病范围之间的关联。
在1年时间里，我们连续纳入了192例患者，这些患者在30天内接受了双同位素应激灌注成像及心导管检查，期间无中间事件或血运重建。测量静息LHR，并检查其与有创测量的血流动力学参数、冠状动脉疾病范围以及静息和应激状态下心肌灌注指标之间的关联。静息铊-201 LHR升高与较低的左心室射血分数（EF）呈弱但显著的关联（r = 0.209，P <.05），与较高的肺毛细血管楔压（r = 0.25，P <.005）及左心室舒张末期压力（r = 0.215，P <.01）相关，但与肺动脉收缩压无关。LHR升高也与静息灌注异常呈弱关联，包括静息总分（r = 0.271，P <.001）及灌注异常节段数（r = 0.25，P <.001），但与应激灌注指标或缺血负荷无关。76例（40%）LHR大于0.5的患者更有可能出现左心室射血分数低于40%及三支血管/左主干冠状动脉疾病。
静息铊-201 LHR升高与较高的左心室舒张末期压力和肺毛细血管楔压及较低的左心室射血分数呈弱关联。LHR也与既往梗死心肌的范围相关，可能提示存在三支血管/左主干冠状动脉疾病。
