Jain A, Myers G H, Rowe M W, Dehmer G J, Robinson D S
University of North Carolina Hospitals, Cardiac Catheterization Laboratory, Chapel Hill.
Angiology. 1991 Feb;42(2):99-105. doi: 10.1177/000331979104200203.
Coronary angiography and left ventriculography is commonly used to identify those patients with incomplete infarctions and therefore, a need for revascularization. The authors compared coronary angiography and left ventriculography with thallium 201 tomography using oral dipyridamole to identify patients with potential ischemia in the infarct zone indicating viable tissue. Forty-five patients (37 men, 8 women) with acute myocardial infarctions (29 anterior, 16 inferior) who received intravenous thrombolytic therapy were studied. On the basis of the left ventriculograms, only 16 patients were judged to have residual function in the infarct zone. Six of these patients had no thallium redistribution in the infarct zone, indicating lack of residual ischemia. Of the 29 patients with no residual function in the infarct zone, 18 had redistribution in the infarct zone, suggesting residual ischemic myocardium and thus viable tissue. Among the 32 patients with open infarct vessels, 15 had no redistribution in the infarct zone, but of the remaining 13 patients with occluded infarct vessels, 9 had redistribution in the infarct zone indicating residual ischemia and thus viable tissue. The authors' data suggest that neither wall motion analysis by left ventriculography nor the angiographic status of the infarct vessel identifies those patients with residual ischemia as evidenced by thallium tomography using oral dipyridamole.
冠状动脉造影和左心室造影常用于识别那些梗死不完全且因此需要血运重建的患者。作者将冠状动脉造影和左心室造影与使用口服双嘧达莫的铊201断层扫描进行比较，以识别梗死区域存在潜在缺血提示有存活心肌组织的患者。对45例接受静脉溶栓治疗的急性心肌梗死患者（37例男性，8例女性）（29例前壁梗死，16例下壁梗死）进行了研究。根据左心室造影，仅16例患者被判定梗死区域有残余功能。其中6例患者梗死区域无铊再分布，提示无残余缺血。在梗死区域无残余功能的29例患者中，18例梗死区域有再分布，提示有残余缺血性心肌，从而有存活心肌组织。在梗死血管通畅的32例患者中，15例梗死区域无再分布，但在其余13例梗死血管闭塞的患者中，9例梗死区域有再分布，提示有残余缺血，从而有存活心肌组织。作者的数据表明，无论是左心室造影的室壁运动分析还是梗死血管的造影状态，均不能识别出使用口服双嘧达莫的铊断层扫描所证实的有残余缺血的患者。
