Her Sung Ho, Yoon Hee Jeoung, Lee Jong Min, Jin Seung Won, Youn Ho Joong, Seung Ki Bae, Kim Jae Hyung
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Nucl Med. 2008 Jul;33(7):459-63. doi: 10.1097/RLU.0b013e3181779271.
The noninvasive differentiation of ischemic from nonischemic cardiomyopathy is clinically important. However, whether adenosine Tc-99m tetrofosmin SPECT can offer clear and accurate information was not known. The aim of this study is to investigate the usefulness of adenosine Tc-99m tetrofosmin SPECT in differentiation of ischemic from nonischemic etiology in patients with mild to severe LV systolic dysfunction and to compare the relationship between patients with mild LV systolic dysfunction and those with severe LV systolic dysfunction.
Seventy-five patients with chronic heart failure (LV ejection fraction <or=50%) underwent adenosine Tc-99m tetrofosmin SPECT and coronary angiography to identify ischemia. The patients were divided into 2 groups based on the result of ejection fraction (EF); group I (44 patients) had mild LV dysfunction, LVEF >35%, group II (31 patients) had severe LV dysfunction, LVEF <or=35%. As the result of SPECT, percent abnormal myocardium was categorized into 3 groups: small defect, <10%; medium defect 10% to 20%; and large defects, >or=20%. Myocardial ischemia was defined by >or=70% stenosis in at least one vessel by coronary angiography.
: In group I, 4 (30.8%) of 13 patients with small defects, 1 (25.0%) of 5 patients with a medium defect, and 22 (84.6%) of 26 patients with large defects demonstrated myocardial ischemia documented by coronary angiography. The relationship between the extent of the SPECT defect and myocardial ischemia was statistically significant in the group I population (P < 0.001). However, in group II, 1 (33.3%) of 3 patients with small defect, 3 (33.3%) of 9 patients with medium defects, and 7 (36.8%) of 19 patients with large defects demonstrated myocardial ischemia confirmed by coronary angiography. There was no statistical relationship between the extent of the SPECT defect and myocardial ischemia in group II.
Adenosine Tc-99m tetrofosmin SPECT is a useful modality to differentiate ischemic from nonischemic etiology in patients with mild LV systolic dysfunction. However, other noninvasive approaches other this SPECT may be considered for confirming the etiology in patients with severe LV systolic dysfunction.
缺血性与非缺血性心肌病的无创鉴别在临床上具有重要意义。然而，尚不清楚锝-99m 替曲膦腺苷单光子发射计算机断层扫描（SPECT）能否提供清晰准确的信息。本研究旨在探讨锝-99m 替曲膦腺苷 SPECT 在轻至重度左心室收缩功能障碍患者中鉴别缺血性与非缺血性病因的实用性，并比较轻度左心室收缩功能障碍患者与重度左心室收缩功能障碍患者之间的关系。
75 例慢性心力衰竭（左心室射血分数≤50%）患者接受了锝-99m 替曲膦腺苷 SPECT 和冠状动脉造影以确定是否存在缺血。根据射血分数（EF）结果将患者分为 2 组；I 组（44 例患者）为轻度左心室功能障碍，左心室射血分数>35%，II 组（31 例患者）为重度左心室功能障碍，左心室射血分数≤35%。作为 SPECT 的结果，异常心肌百分比分为 3 组：小缺损，<10%；中等缺损，10%至 20%；大缺损，≥20%。心肌缺血由冠状动脉造影显示至少一支血管狭窄≥70%定义。
在 I 组中，13 例小缺损患者中有 4 例（30.8%）、5 例中等缺损患者中有 1 例（25.0%）、26 例大缺损患者中有 22 例（84.6%）经冠状动脉造影证实存在心肌缺血。I 组人群中 SPECT 缺损程度与心肌缺血之间的关系具有统计学意义（P<0.001）。然而，在 II 组中，3 例小缺损患者中有 1 例（33.3%）、9 例中等缺损患者中有 3 例（33.3%）、19 例大缺损患者中有 7 例（36.8%）经冠状动脉造影证实存在心肌缺血。II 组中 SPECT 缺损程度与心肌缺血之间无统计学关系。
锝-99m 替曲膦腺苷 SPECT 是鉴别轻度左心室收缩功能障碍患者缺血性与非缺血性病因的有用方法。然而，对于重度左心室收缩功能障碍患者，可能需要考虑使用除该 SPECT 之外的其他无创方法来确定病因。
