Irie Hidekazu, Ito Kazuki, Koide Masahiro, Taniguchi Takuya, Yokoi Hirokazu, Nakamura Reo, Kinoshita Noriyuki, Hashimoto Tetsuo, Tamaki Shunichi, Sawada Takahisa, Azuma Akihiro, Matsubara Hiroaki
Department of Cardiology, Kouseikai Takeda Hospital.
Kaku Igaku. 2006 May;43(2):85-91.
An 86-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed 99% stenosis of the mid segment of the left anterior descending coronary artery, therefore, a coronary stent was implanted. Immediately after the stent implantation, 99% stenosis occurred at the proximal site of the 1st diagonal artery because of stent jeal. On the 4th hospital day, ECG-gated 201TL/99mTc-PYP dual myocardial quantitative gated SPECT was performed at rest and during low-dose dobutamine loading. The 201Tl scintigraphy revealed moderately reduced uptake in the anterior, septal and apical walls, and 99mTc-PYP uptake was observed in the mid-anterior wall. A three-dimensional surface display of gated 201Tl SPECT images showed severe hypokinesis in the anterior, septal and apical walls at rest. On the other hand, during low-dose dobutamine loading, improved wall motion was observed in the basal anterior and septal walls, while no change was observed in the midanterior and apical wall movements. Three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed similar patterns of wall motion as those of gated 201Tl SPECT images at rest. During low-dose dobutamine loading, on the other hand, a three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed improved wall motion in the basal anterior, septal and apical walls, but worsened wall motion of the mid-anterior wall. After 6 months, a follow-up coronary angiography revealed no re-stenosis of the stent, but 99% stenosis at the proximal aspect of the 1st diagonal artery. Left ventriculography revealed improved wall motion in the apex and akinesis of the mid-anterior wall. These wall motion findings were similar to those visualized in the three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images during low-dose dobutamine loading in the acute phase. These results suggest that 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT using low-dose dobutamine loading could be useful for the assessment of myocardial viability after reperfusion therapy in patients with acute myocardial infarction.
一名86岁胸痛男性入住我院。冠状动脉造影显示左前降支冠状动脉中段狭窄99%，因此植入了冠状动脉支架。支架植入后立即，由于支架重叠，第一对角支动脉近端出现99%的狭窄。在住院第4天，在静息状态和低剂量多巴酚丁胺负荷期间进行了心电图门控的201Tl/99mTc-PYP双核素心肌定量门控SPECT检查。201Tl心肌显像显示前壁、间隔壁和心尖壁摄取中度降低，在前壁中部观察到99mTc-PYP摄取。门控201Tl SPECT图像的三维表面显示显示静息状态下前壁、间隔壁和心尖壁严重运动减弱。另一方面，在低剂量多巴酚丁胺负荷期间，在前壁基部和间隔壁观察到壁运动改善，而在前壁中部和心尖壁运动未观察到变化。门控201Tl/99mTc-PYP双核素SPECT图像的三维表面显示显示静息状态下壁运动模式与门控201Tl SPECT图像相似。另一方面，在低剂量多巴酚丁胺负荷期间，门控201Tl/99mTc-PYP双核素SPECT图像的三维表面显示显示前壁基部、间隔壁和心尖壁壁运动改善，但前壁中部壁运动恶化。6个月后，随访冠状动脉造影显示支架无再狭窄，但第一对角支动脉近端有99%的狭窄。左心室造影显示心尖壁运动改善，前壁中部运动消失。这些壁运动表现与急性期低剂量多巴酚丁胺负荷期间门控201Tl/99mTc-PYP双核素SPECT图像的三维表面显示中观察到的相似。这些结果表明，使用低剂量多巴酚丁胺负荷的201Tl/99mTc-PYP双核素心肌定量门控SPECT可能有助于评估急性心肌梗死患者再灌注治疗后的心肌活力。
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