Yoshibayashi M, Tamaki N, Nishioka K, Matsumura M, Ueda T, Temma S, Yonekura Y, Yamashita K, Konishi J, Mikawa H
Department of Pediatrics, Kyoto University School of Medicine, Japan.
Am J Cardiol. 1991 Dec 15;68(17):1638-45. doi: 10.1016/0002-9149(91)90322-c.
To clarify the significance of newly appearing abnormal Q waves and their disappearance in patients with Kawasaki disease, regional myocardial perfusion and glucose metabolism at rest in the fasting condition were assessed by positron emission tomography (PET) with 13N-ammonia and 18F-fluorodeoxyglucose (FDG), and regional wall motion by left ventriculography in regions with persistent and transient abnormal Q waves in 14 patients. PET identified 3 groups of abnormal myocardial segments: segments with hypoperfusion without increased FDG uptake, those with hypoperfusion and increased FDG uptake, and those with normal perfusion and increased FDG uptake. Almost all the segments with persistent or transient abnormal Q waves had abnormal PET findings. PET demonstrated evidence of metabolic activity in 57% of segments with persistent abnormal Q waves and 67% of those with transient abnormal Q waves. Regional wall motion, scored from 0 (normal) to 4 (dyskinesia), was not significantly different between segments with persistent and transient abnormal Q waves (2.3 +/- 1.3 vs 2.2 +/- 1.2). The persistence of abnormal Q waves on serial electrocardiograms was significantly shorter in metabolically active than in inactive segments (19 +/- 17 vs 92 +/- 27 months). In conclusion, in patients with Kawasaki disease, the new appearance of abnormal Q waves is a reliable clue to the presence of ischemic myocardial injury and a high proportion of them are associated with metabolically active myocardial regions. The disappearance of abnormal Q waves does not necessarily mean the normalization of regional myocardial perfusion, metabolism or function, and their early disappearance may imply "viability" in the associated myocardial region.
为阐明川崎病患者新出现的异常Q波及其消失的意义，采用正电子发射断层扫描（PET）结合13N-氨和18F-氟脱氧葡萄糖（FDG）评估14例患者在空腹静息状态下的局部心肌灌注和葡萄糖代谢，并通过左心室造影评估持续性和短暂性异常Q波区域的局部室壁运动。PET识别出3组异常心肌节段：灌注减低但FDG摄取未增加的节段、灌注减低且FDG摄取增加的节段以及灌注正常但FDG摄取增加的节段。几乎所有持续性或短暂性异常Q波的节段均有PET异常表现。PET显示，57%的持续性异常Q波节段和67%的短暂性异常Q波节段有代谢活性证据。局部室壁运动评分从0（正常）至4（运动障碍），持续性和短暂性异常Q波节段之间无显著差异（2.3±1.3对2.2±1.2）。系列心电图上异常Q波的持续时间在代谢活跃节段显著短于不活跃节段（19±17对92±27个月）。总之，在川崎病患者中，异常Q波的新出现是缺血性心肌损伤存在的可靠线索，且其中很大一部分与代谢活跃的心肌区域相关。异常Q波的消失并不一定意味着局部心肌灌注、代谢或功能恢复正常，其早期消失可能意味着相关心肌区域具有“存活能力”。
