[急性心肌梗死患者侧支循环对心肌保护的作用：锝-99m-替曲膦心肌单光子发射计算机断层扫描与冠状动脉造影的比较]

[Effect of collateral circulation on myocardial protection in patients with acute myocardial infarction: comparison of technetium-99m-tetrofosmin myocardial single photon emission computed tomography and coronary angiography].

作者信息

Yoshida Michi, Kondo Makoto, Abe Yoshiteru, Kubota Tomoyuki, Matsuoka Ryota, Araki Makoto, Tanio Hitoshi, Doyama Kiyoshi

机构信息

Division of Cardiology, Shimada Municipal Hospital, Noda 1200-5, Shimada, Shizuoka 427-8502.

出版信息

J Cardiol. 2006 Mar;47(3):115-21.

PMID:16570533

Abstract

OBJECTIVES

Evaluation of myocardial blood flow from collateral vessels into the infarct area has been estimated by coronary angiography. In patients with acute myocardial infarction with Thrombolysis in Myocardial Infarction (TIMI) 0 flow, myocardial tracer uptake on single photon emission computed tomography (SPECT) images can predict the collateral blood flow in the infarct area if technetium (Tc)-99m-tetrofosmin was administered before recanalization. The present study investigated whether collateral blood flow evaluated by myocardial scintigraphy is a good predictor of myocardial salvage in patients with acute myocardial infarction.

METHODS

The study group consisted of 30 patients (mean age 65 +/- 14 years, 23 males, 7 females) with first acute myocardial infarction and coronary angiography evidence of total occlusion (TIMI 0) within 12 hr after the onset. All patients had one vessel disease related to infarction and TIMI 3 flow after percutaneous coronary intervention (PCI). Tc-99m-tetrofosmin was injected intravenously before the PCI. The regional severity score index (RSSI) was obtained from SPECT using the 17 segment method with the four-point scoring system. Myocardial viability was evaluated by the RSSI obtained from thallium-glucose-insulin infusion SPECT after 1 week and regional wall motion score index obtained from echocardiography during the chronic phase.

RESULTS

The patients were divided into two groups according to the angiographic collateral finding. There were no differences in RSSI on thallium-glucose-insulin SPECT and regional wall motion score between the good collateral group (n = 8) and poor collateral group (n = 22). Myocardial Tc-99m-tetrofosmin RSSI was similar in these groups. On the other hand, the patients were divided according to Tc-99m-tetrofosmin scintigraphic evaluation before PCI. RSSI on thallium-glucose-insulin SPECT was significantly greater (0.7 +/- 0.5 vs 1.5 +/- 0.4, p < 0.01) and regional wall motion score was significantly less (1.46 +/- 0.50 vs 2.08 +/- 0.78, p < 0.05) in the lower Tc-99m-tetrofosmin RSSI (< 1.9) group (n = 22) compared with the higher RSSI (> or = 1.9) group (n = 8). In addition, a significant correlation was obtained between Tc-99 m-tetrofosmin RSSI and regional wall motion score index (r = 0.53, p < 0.01).

CONCLUSIONS

The collateral flow evaluated by scintigraphy was significantly correlated with myocardial viability.

摘要

目的

通过冠状动脉造影评估梗死区域侧支血管的心肌血流情况。在心肌梗死溶栓治疗（TIMI）血流为0级的急性心肌梗死患者中，如果在再灌注前注射锝（Tc）-99m-替曲膦，单光子发射计算机断层扫描（SPECT）图像上的心肌示踪剂摄取情况可预测梗死区域的侧支血流。本研究探讨了心肌闪烁显像评估的侧支血流是否是急性心肌梗死患者心肌挽救的良好预测指标。

方法

研究组由30例首次发生急性心肌梗死且发病后12小时内冠状动脉造影显示完全闭塞（TIMI 0级）的患者组成（平均年龄65±14岁，男性23例，女性7例）。所有患者均为与梗死相关的单支血管病变，经皮冠状动脉介入治疗（PCI）后TIMI血流为3级。在PCI前静脉注射Tc-99m-替曲膦。使用17节段法和四点评分系统从SPECT获得区域严重程度评分指数（RSSI）。通过1周后铊-葡萄糖-胰岛素输注SPECT获得的RSSI以及慢性期超声心动图获得的区域壁运动评分指数评估心肌存活情况。

结果

根据血管造影侧支情况将患者分为两组。良好侧支组（n = 8）和不良侧支组（n = 22）在铊-葡萄糖-胰岛素SPECT上的RSSI和区域壁运动评分无差异。这些组中心肌Tc-99m-替曲膦RSSI相似。另一方面，根据PCI前Tc-⑨9m-替曲膦闪烁显像评估将患者分组。与较高RSSI（≥1.9）组（n = 8）相比，较低Tc-99m-替曲膦RSSI（<1.9）组（n = 22）在铊-葡萄糖-胰岛素SPECT上的RSSI显著更高（0.7±0.5对1.5±0.4，p<0.01），区域壁运动评分显著更低（1.46±0.50对2.08±0.78，p<0.05）。此外，Tc-99m-替曲膦RSSI与区域壁运动评分指数之间存在显著相关性（r = 0.53，p<0.01）。