Martinez E E, Horowitz S F, Castello H J, Castiglioni M L, Carvalho A C, Almeida D R, Roberti R R, Saragoça M A, Barbieri A
Division of Cardiology, Escola Paulista de Medicina, Såo Paulo, Brazil.
Am Heart J. 1992 Feb;123(2):427-32. doi: 10.1016/0002-8703(92)90657-h.
Increased lung thallium-201 activity occurs with exercise in patients with severe coronary artery disease as a result of increased pulmonary capillary wedge pressure. No study has shown resting lung kinetics in chronic congestive heart failure. To better understand the relationship between lung and myocardial thallium uptake and pulmonary capillary wedge pressure, this study was performed. Resting lung and myocardial thallium uptake, expressed as a ratio, were compared with simultaneous pulmonary capillary wedge pressure in 16 patients with congestive heart failure and cardiomyopathy, all New York Heart Association class IV. There were no variations in pulmonary capillary wedge pressure throughout the study protocol. There was a significant reduction in the lung/myocardium thallium ratio from 10 to 60 minutes (0.83 +/- 0.30 to 0.59 +/- 0.17; p less than 0.001). At 60 minutes after thallium injection there was a linear correlation between the lung/myocardium ratio and capillary wedge pressure with an r value of 0.62 (p less than 0.01). Thus thallium-201 washout is rapid despite persistence of pulmonary capillary wedge pressure elevation, indicating that clearance does not imply resolution of congestive heart failure. In addition, a significant but imprecise correlation was found between capillary pressure and the lung/myocardium ratio. Rapid changes in lung activity during the early postinjection period may limit the clinical use of the lung/myocardium ratio.
严重冠状动脉疾病患者运动时，由于肺毛细血管楔压升高，肺部铊-201活性增加。尚无研究表明慢性充血性心力衰竭患者静息时的肺部动力学情况。为了更好地理解肺部和心肌铊摄取与肺毛细血管楔压之间的关系，开展了本研究。对16例充血性心力衰竭和心肌病患者（均为纽约心脏病协会IV级）静息时的肺部和心肌铊摄取（以比值表示）与同步肺毛细血管楔压进行了比较。在整个研究方案中，肺毛细血管楔压没有变化。注射铊后10至60分钟，肺/心肌铊比值显著降低（从0.83±0.30降至0.59±0.17；p<0.001）。注射铊后60分钟，肺/心肌比值与毛细血管楔压之间存在线性相关性，r值为0.62（p<0.01）。因此，尽管肺毛细血管楔压持续升高，但铊-201的洗脱很快，这表明清除并不意味着充血性心力衰竭得到缓解。此外，毛细血管压与肺/心肌比值之间存在显著但不精确的相关性。注射后早期肺部活性的快速变化可能会限制肺/心肌比值的临床应用。
