Takeishi Y, Tono-oka I, Ikeda K, Komatani A, Tsuiki K, Yasui S
First Department of Internal Medicine, Yamagata University School of Medicine, Japan.
Am Heart J. 1991 Feb;121(2 Pt 1):466-75. doi: 10.1016/0002-8703(91)90713-r.
To investigate the significance and mechanism of dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging, we performed both dipyridamole thallium-201 imaging and dipyridamole radionuclide angiography on 83 patients with known angiograms. The dipyridamole/delayed ratio of the left ventricular dimension from the thallium-201 image was defined as the left ventricular dilatation ratio (LVDR). An LVDR greater than the mean + two standard deviations in patients without coronary artery disease was defined as abnormal. Twenty-two of 83 patients showed an abnormal LVDR, and 18 of the 22 patients (82%) had triple-vessel disease. By defect and washout analysis, the sensitivity and specificity for correctly identifying the patients as having triple-vessel disease was 72% and 76%, respectively, whereas LVDR had a sensitivity of 72% and a specificity of 93%. When LVDR was used in combination with the defect and washout criteria, sensitivity increased to 84% without a loss of specificity. In those 22 patients with abnormal LVDRs, end-diastolic volume measured by radionuclide angiography did not change after dipyridamole infusion. Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging reflected relative subendocardial hypoperfusion induced by dipyridamole rather than actual chamber enlargement. The LVDR was moderately sensitive and highly specific for triple-vessel disease and provided complementary information to dipyridamole thallium-201 imaging.
为了研究双嘧达莫 - 铊 - 201心肌显像中左心室腔扩张的意义及机制，我们对83例已知血管造影结果的患者进行了双嘧达莫 - 铊 - 201心肌显像和双嘧达莫放射性核素血管造影。铊 - 201图像中左心室维度的双嘧达莫/延迟比值被定义为左心室扩张率（LVDR）。无冠状动脉疾病患者中LVDR大于均值加两个标准差被定义为异常。83例患者中有22例LVDR异常，其中18例（82%）患有三支血管病变。通过缺损和洗脱分析，正确识别患有三支血管病变患者的敏感性和特异性分别为72%和76%，而LVDR的敏感性为72%，特异性为93%。当LVDR与缺损和洗脱标准联合使用时，敏感性提高到84%，而特异性未降低。在这22例LVDR异常的患者中，放射性核素血管造影测量的舒张末期容积在输注双嘧达莫后未发生变化。双嘧达莫 - 铊 - 201心肌显像中的左心室腔扩张反映了双嘧达莫诱导的相对心内膜下灌注不足，而非实际心室扩大。LVDR对三支血管病变具有中度敏感性和高度特异性，并为双嘧达莫 - 铊 - 201心肌显像提供了补充信息。
