Honda T, Jo T, Doiuchi J, Ochi N, Sato A, Suetsugu M, Nishitani K, Hamada N, Nomoto R, Akamatsu A
Department of Internal Medicine, Ehime Prefectural Central Hospital, Matsuyama.
J Cardiol. 1992;22(1):33-41.
To evaluate the effects of percutaneous transluminal coronary angioplasty (PTCA), we investigated myocardial ischemia and left ventricular function during exercise before and after successful PTCA in 30 patients. We used extent and severity scores of 201thallium (201Tl) exercise myocardial scintigraphy to assess myocardial ischemia and determined global and regional left ventricular ejection fraction (EF and REF) of 99mTc-RBC exercise radionuclide ventriculography to assess left ventricular function. The extent and severity scores of stress images were significantly less after PTCA than before PTCA. The scores of the redistribution images were unchanged before and after PTCA. Global EF during exercise was significantly higher after PTCA than before PTCA. There was no difference in resting global EF between before and after PTCA. Myocardial ischemia induced by exercise was semi-quantitatively analyzed as transient perfusion defect with severity score. Severity score was significantly less after PTCA than before PTCA. delta EF, which was obtained by subtraction of resting global EF from exercise one, was significantly higher after PTCA than before PTCA. However, the degree of improvement in myocardial ischemia and left ventricular function varied from patient to patient. In 17 patients with one-vessel left anterior descending artery disease, delta REF, which was determined by subtracting resting regional EF from exercise one, was significantly higher in septal and apical segments after PTCA than before PTCA. Myocardial ischemia and left ventricular function under exercise were alleviated by PTCA. However, the degree of improvement varied from patient to patient and it might have been affected by various factors including coronary dissection, edema, thrombus, restenosis, spasm, side branch stenosis or occlusion, distal thrombus, and myocardial hibernation.
为评估经皮腔内冠状动脉成形术（PTCA）的效果，我们对30例患者成功进行PTCA前后运动期间的心肌缺血和左心室功能进行了研究。我们使用201铊（201Tl）运动心肌闪烁显像的范围和严重程度评分来评估心肌缺血，并通过99m锝-红细胞（99mTc-RBC）运动放射性核素心室造影测定整体和局部左心室射血分数（EF和REF）来评估左心室功能。PTCA后应激图像的范围和严重程度评分显著低于PTCA前。再分布图像的评分在PTCA前后未发生变化。运动期间的整体EF在PTCA后显著高于PTCA前。PTCA前后静息时的整体EF无差异。运动诱发的心肌缺血通过严重程度评分的短暂灌注缺损进行半定量分析。PTCA后严重程度评分显著低于PTCA前。通过运动时的整体EF减去静息时的整体EF得到的ΔEF在PTCA后显著高于PTCA前。然而，心肌缺血和左心室功能的改善程度因患者而异。在17例单支左前降支病变患者中，通过运动时的局部EF减去静息时的局部EF得到的ΔREF在PTCA后间隔和心尖节段显著高于PTCA前。PTCA可缓解运动时的心肌缺血和左心室功能。然而，改善程度因患者而异，可能受到多种因素影响，包括冠状动脉夹层、水肿、血栓形成、再狭窄、痉挛、侧支狭窄或闭塞、远端血栓以及心肌冬眠。
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