Mori T, Yamabe H, Yoshida H, Maeda K, Fukuzaki H
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Jpn Circ J. 1991 Feb;55(2):99-108. doi: 10.1253/jcj.55.99.
To clarify the clinical significance of resting thallium-201 (Tl) delayed SPECT for assessing the viability of infarcted regions, we studied resting Tl initial and delayed Tl SPECT one week after exercise (Ex) Tl SPECT in 38 patients (40 regions) with old myocardial infarction (OMI) and 35 patients (37 regions) with effort angina pectoris (EAP). Analysis of resting Tl and Ex Tl SPECT divided the patients with OMI into 3 groups. Twenty-three patients whose perfusion defect (PD) on resting delayed image was same as that of Ex delayed image were divided into 12 patients with Ex Tl redistribution (RD) (G1) and 11 patients without Ex Tl RD (G3). Fifteen patients showed a decrease of PD on resting delayed image compared with Ex delayed image (G2). Thirty-five patients with EAP were divided into 18 patients who had no PD on Ex delayed image (G1) and 17 patients whose PD did not disappear on Ex delayed image but disappeared on resting delayed image (G2). The increase of pulmonary artery wedge pressure on Ex was higher in G2 than in G1 of both OMI and EAP (OMI; G1 15 +/- 16 mmHg vs G2 27 +/- 7 mmHg; p less than 0.01, EAP; G1 12 +/- 7 mmHg vs G2 22 +/- 6 mmHg; p less than 0.05). The percent Tl uptake of the PD on Ex Tl initial images was lower in G2 than in G1 of both OMI and EAP (OMI: G1 63 +/- 7% vs G2 55 +/- 9%; p less than 0.05, EAP: G1 72 +/- 7% vs G2 65 +/- 9%; p less than 0.05). That of the PD on resting Tl delayed images was higher in G1 and G2 than in G3 of OMI (G1 78 +/- 7%, G2 74 +/- 8%, G3 41 +/- 10%; G1 vs G3, G2 vs G3 p less than 0.001). The prevalence of akinetic or dyskinetic wall motion on left ventriculography was higher in G2 than G1, and in G3 than G2 (G1 24.3%, G2 52.2%, G3 85.7%; p less than 0.001). Thus, in patients with OMI the decrease of Tl PD on resting Tl delayed images compared with Ex delayed images may indicate severe ischemia induced by stress as well as in patients with EAP, and furthermore the presence of viable muscle. On the other hand, the infarcted region without decrease of Tl PD on resting delayed images may lack viable muscle.
为阐明静息铊-201（Tl）延迟单光子发射计算机断层扫描（SPECT）对评估梗死区域存活心肌的临床意义，我们对38例陈旧性心肌梗死（OMI）患者（40个区域）和35例劳力性心绞痛（EAP）患者（37个区域）进行了研究，在运动（Ex）铊SPECT检查一周后行静息Tl初始和延迟Tl SPECT检查。对静息Tl和Ex Tl SPECT的分析将OMI患者分为3组。23例静息延迟图像上灌注缺损（PD）与Ex延迟图像相同的患者被分为12例有Ex Tl再分布（RD）的患者（G1组）和11例无Ex Tl RD的患者（G3组）。15例患者静息延迟图像上的PD较Ex延迟图像减少（G2组）。35例EAP患者被分为18例Ex延迟图像上无PD的患者（G1组）和17例Ex延迟图像上PD未消失但在静息延迟图像上消失的患者（G2组）。OMI和EAP的G2组运动时肺动脉楔压的升高均高于G1组（OMI：G1组15±16 mmHg，G2组27±7 mmHg；p＜0.01，EAP：G1组12±7 mmHg，G2组22±6 mmHg；p＜0.05）。OMI和EAP的G2组Ex Tl初始图像上PD的铊摄取百分比均低于G1组（OMI：G1组63±7%，G2组55±9%；p＜0.05，EAP：G1组72±7%，G2组65±9%；p＜0.05）。OMI的G1组和G2组静息Tl延迟图像上PD的铊摄取百分比高于G3组（G1组78±7%，G2组74±8%，G3组41±10%；G1组与G3组、G2组与G3组比较p＜0.001）。左心室造影显示运动减弱或运动障碍性室壁运动的发生率G2组高于G1组，G3组高于G2组（G1组24.3%，G2组52.2%，G3组85.7%；p＜0.001）。因此，在OMI患者中，与Ex延迟图像相比，静息Tl延迟图像上Tl PD的减少可能表明与EAP患者一样，应激诱导了严重缺血，并且还存在存活心肌。另一方面，静息延迟图像上Tl PD无减少的梗死区域可能缺乏存活心肌。
