Hernandez-Pampaloni Miguel, Bax Jeroen J, Morita Koichi, Dutka David P, Camici Paolo G
Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, Imperial College, London, UK.
Eur J Nucl Med Mol Imaging. 2005 Mar;32(3):314-21. doi: 10.1007/s00259-004-1682-y. Epub 2004 Oct 12.
Different criteria to identify residual viability in chronically dysfunctioning myocardium in patients with coronary artery disease (CAD) can be derived by the combined assessment of myocardial blood flow (MBF) and glucose utilisation (MRG) using positron emission tomography (PET). The aim of this study was to evaluate, in a large number of patients, the prevalence of these different patterns by purely quantitative means.
One hundred and sixteen consecutive patients with ischaemic cardiomyopathy (LVEF < or =40%) underwent resting 2D echocardiography to assess regional contractile function (16-segment model). PET with 15O-labelled water (H2 15O) and 18F-fluorodeoxyglucose (FDG) was used to quantify MBF and MRG during hyperinsulinaemic euglycaemic clamp. Dysfunctional segments with normal MBF (> or =0.6 ml min(-1) g(-1)) were classified as stunned, and segments with reduced MBF (<0.6 ml min(-1) g(-1)) as hibernating if MRG was > or =0.25 micromol min(-1) g(-1). Segments with reduced MBF and MRG <0.20 micromol min(-1) g(-1) were classified as transmural scars and segments with reduced MBF and MRG between 0.20 and 0.25 micromol min(-1) g(-1) as non-transmural scars.
Eight hundred and thirty-four (46%) segments were dysfunctional. Of these, 601 (72%) were chronically stunned, with 368 (61%) having normal MRG (0.47+/-0.20 micromol min(-1) g(-1)) and 233 (39%) reduced MRG (0.16+/-0.05 micromol min(-1) g(-1)). Seventy-four (9%) segments with reduced MBF had preserved MRG (0.40+/-0.18 micromol min(-1) g(-1)) and were classified as hibernating myocardium. In addition, 15% of segments were classified as transmural and 4% as non-transmural scar. The mean MBF was highest in stunned myocardium (0.95+/-0.32 ml min(-1) g(-1)), intermediate in hibernating myocardium and non-transmural scars (0.47+/-0.09 ml min(-1) g(-1) and 0.48+/-0.08 ml min(-1) g(-1), respectively), and lowest in transmural scars (0.40+/-0.14 ml min(-1) g(-1), P<0.01). MRG was comparable in hibernating and stunned myocardium with preserved MRG (0.40+/-0.19 micromol min(-1) g(-1) vs 0.46+/-0.20 micromol min(-1) g(-1), NS), and lowest in stunned myocardium with reduced MRG and transmural scars.
Chronic stunning is more prevalent than expected. The degree of MRG reduction in stunned myocardium may disclose segments at higher risk of permanent damage.
通过使用正电子发射断层扫描（PET）联合评估心肌血流（MBF）和葡萄糖利用（MRG），可以得出识别冠心病（CAD）患者慢性功能障碍心肌中残余存活能力的不同标准。本研究的目的是通过纯定量方法评估大量患者中这些不同模式的患病率。
116例连续性缺血性心肌病患者（左心室射血分数≤40%）接受静息二维超声心动图检查以评估局部收缩功能（16节段模型）。使用15O标记水（H215O）和18F-氟脱氧葡萄糖（FDG）的PET在高胰岛素正常血糖钳夹期间定量MBF和MRG。MBF正常（≥0.6 ml·min-1·g-1）的功能障碍节段分类为顿抑，MBF降低（<0.6 ml·min-1·g-1）且MRG≥0.25 μmol·min-1·g-1的节段分类为冬眠。MBF降低且MRG<0.20 μmol·min-1·g-1的节段分类为透壁瘢痕，MBF降低且MRG在0.20至0.25 μmol·min-1·g-1之间的节段分类为非透壁瘢痕。
834个（46%）节段功能障碍。其中，601个（72%）为慢性顿抑，368个（61%）MRG正常（0.47±0.20 μmol·min-1·g-1），233个（39%）MRG降低（0.16±0.05 μmol·min-1·g-1）。74个（9%）MBF降低的节段MRG保留（0.40±0.18 μmol·min-1·g-1），分类为冬眠心肌。此外，15%的节段分类为透壁瘢痕，4%为非透壁瘢痕。顿抑心肌的平均MBF最高（0.95±0.32 ml·min-1·g-1），冬眠心肌和非透壁瘢痕居中（分别为0.47±0.09 ml·min-1·g-1和0.48±0.08 ml·min-1·g-1），透壁瘢痕最低（0.40±0.14 ml·min-1·g-1，P<0.01）。冬眠心肌和MRG保留的顿抑心肌的MRG相当（0.40±0.19 μmol·min-1·g-1对0.46±0.20 μmol·min-1·g-1，无显著性差异），MRG降低的顿抑心肌和透壁瘢痕最低。
慢性顿抑比预期更普遍。顿抑心肌中MRG降低的程度可能揭示永久性损伤风险较高的节段。
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