Demir Hakan, Tan Yusuf Z, Isgoren Serkan, Gorur Gozde D, Kozdag Guliz, Ural Ertan, Berk Fatma
Department of Nuclear Medicine, Kocaeli University School of Medicine, Umuttepe Yerleskesi, 41380 Kocaeli, Turkey.
Ann Nucl Med. 2008 Jun;22(5):403-9. doi: 10.1007/s12149-008-0119-2. Epub 2008 Jul 4.
Transient left ventricular contractile dysfunction (TLVD) is observed owing to post-exercise stunning in patients with coronary artery disease (CAD). Pharmacological stimulation differs from exercise stress because it does not cause demand ischemia. The aim of this study was to determine whether TLVD could also be seen after pharmacological stress (dipyridamole).
Of the patients in whom gated single-photon emission computed tomography (GSPECT) was performed in our institution from January 2004 to April 2007, 439 subjects with known or suspected CAD were included in the study. GSPECT was performed for all patients following exercise (group I, n = 220) or pharmacological stress (group II, n = 219) according to a 2-day (stress-rest) protocol after injection of Tc-99m methoxyisobutyl-isonitrile (MIBI). Stress, rest, and difference (stress-rest value) left ventricular ejection fractions (SLVEF, RLVEF, and DLVEF) and transient ischemic dilatation (TID) ratio were derived automatically. Summed stress score, summed rest score, and summed difference score (SDS) for myocardial perfusion were calculated using a 20-segment model and a five-point scoring system. An SDS > 3 was considered as ischemic. On the basis of the perfusion findings, patients were subdivided into a normal (group A, n = 216) and ischemia group (group B, n = 223). DLVEF and perfusion scores of all groups were compared. Relationships between DLVEF and perfusion, and between TID ratio and DLVEF were also evaluated.
Stress-induced ischemia was observed in 223 of 439 patients (50.8%). In group A, the difference between stress and rest LVEF values was not significant (P = 0.670 and P = 0.200 for groups IA and IIA, respectively). However, LVEF was significantly decreased after stress compared with rest values for group B (P < 0.0001 for groups IB and IIB). TLVD (< or =-5% for DLVEF) was observed in 20 of 216 (9%) and 81 of 223 subjects (36%) in patients in groups A and B, respectively (P < 0.0001). In group I, we found TLVD in 46 of 119 (39%) and 12 of 101 (12%) subjects, in patients with and without ischemia, respectively (P < 0.0001). On the other hand, in group II, TLVD was detected in 35 of 104 (34%) and 8 of 115 (7%) patients with and without ischemia, respectively (P < 0.0001). And also, we found significant good correlations between TID ratios and DLVEF values in four subgroups (r = -0.55, r = -0.62, r = -0.59, and r = -0.41; for groups IA, IB, IIA, and IIB, respectively, P < 0.0001 for all).
Dipyridamole is believed to be less likely than exercise to induce ischemia. However, in this study, TLVD after stress was observed following not only exercise but also pharmacological stress, consistent with ischemia.
在冠心病（CAD）患者中，运动后心肌顿抑可导致短暂性左心室收缩功能障碍（TLVD）。药物刺激与运动应激不同，因为它不会引起需求性缺血。本研究的目的是确定在药物应激（双嘧达莫）后是否也能观察到TLVD。
2004年1月至2007年4月在我院接受门控单光子发射计算机断层扫描（GSPECT）的患者中，439例已知或疑似CAD的患者被纳入研究。根据2天（应激-静息）方案，在注射锝-99m甲氧基异丁基异腈（MIBI）后，对所有患者进行运动（I组，n = 220）或药物应激（II组，n = 219）后的GSPECT检查。自动得出应激、静息和差值（应激-静息值）左心室射血分数（SLVEF、RLVEF和DLVEF）以及短暂性缺血性扩张（TID）比值。使用20节段模型和五点评分系统计算心肌灌注的总应激评分、总静息评分和总差值评分（SDS）。SDS>3被认为是缺血性的。根据灌注结果，患者被分为正常组（A组，n = 216）和缺血组（B组，n = 223）。比较所有组的DLVEF和灌注评分。还评估了DLVEF与灌注之间以及TID比值与DLVEF之间的关系。
439例患者中有223例（50.8%）观察到应激性缺血。在A组中，应激和静息LVEF值之间的差异无统计学意义（IA组和IIA组分别为P = 0.670和P = 0.200）。然而，与静息值相比，B组应激后LVEF显著降低（IB组和IIB组均为P < 0.0001）。A组216例患者中有20例（9%）和B组223例患者中有81例（36%）观察到TLVD（DLVEF≤ -5%）（P < 0.0001）。在I组中，有缺血和无缺血的患者中分别有46例（39%）和12例（12%）观察到TLVD（P < 0.0001）。另一方面，在II组中，有缺血和无缺血的患者中分别有35例（34%）和8例（7%）检测到TLVD（P < 0.0001）。此外，我们在四个亚组中发现TID比值与DLVEF值之间存在显著的良好相关性（r = -0.55、r = -0.62、r = -0.59和r = -0.41；分别对应IA组、IB组、IIA组和IIB组，所有P < 0.0001）。
双嘧达莫被认为比运动诱发缺血的可能性小。然而，在本研究中，不仅运动后，而且药物应激后也观察到应激后TLVD，这与缺血一致。
