Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
Ann Nucl Med. 2011 Dec;25(10):740-8. doi: 10.1007/s12149-011-0519-6. Epub 2011 Jul 28.
This study aimed to clarify the correlation between the myocardial washout rate (WR) of technetium-99m hexakis 2-methoxy-isobutyl-isonitrile ((99m)Tc-sestamibi) and cardiac enzyme levels in patients with acute myocardial infarction (AMI) 6 months after the onset.
Sixty-one consecutive AMI patients (mean age, 66.2 ± 9.7 years) who underwent percutaneous coronary intervention (PCI) on admission were enrolled. Creatinine kinase MB isoenzyme (CK-MB) levels were measured every 3 h. (99m)Tc-sestamibi myocardial scintigraphic images were obtained at the early (30 min) and delayed (4 h) phases after tracer injection for calculating heart-to-mediastinum (H/M) ratios and global WRs at 2 weeks (0 M) and 6 months (6 M) after the onset of AMI. Regional WRs in the culprit lesions (culprit WR) and the extent score (ES) and severity score (SS) of myocardial damage were also calculated.
PCI was performed 8.3 ± 7.7 h after AMI onset. At 6 M, the early H/M ratio (p = 0.04), delayed H/M ratio (p = 0.02), global WR (p = 0.01), culprit WR (p = 0.002), and delayed ES (p = 0.008) were alleviated. At 0 M, the peak CK-MB level correlated with the delayed H/M ratio (p = 0.003), global WR (p = 0.003), culprit WR (p < 0.001), early ES (p = 0.03), delayed ES (p = 0.01), early SS (p = 0.001), and delayed SS (p < 0.001). At 6 M, the peak CK-MB level correlated with the delayed H/M ratio (p < 0.001), global WR (p = 0.005), culprit WR (p = 0.001), early ES (p = 0.001), delayed ES (p < 0.001), early SS (p < 0.001), and delayed SS (p < 0.001).
These results demonstrated that (99m)Tc-sestamibi WR in the chronic phase as well as that in the acute phase reflects the extent of initial myocardial damage in AMI patients after PCI. Moreover, it might indicate the myocardial condition in the clinical course.
本研究旨在明确心肌灌注闪烁显像中锝-99m 六甲撑异腈（99mTc-sestamibi）洗脱率（WR）与急性心肌梗死（AMI）发病 6 个月后患者的心肌酶水平之间的相关性。
共纳入 61 例连续的 AMI 患者（平均年龄 66.2±9.7 岁），这些患者在入院时接受了经皮冠状动脉介入治疗（PCI）。每 3 小时测量肌酸激酶同工酶 MB（CK-MB）水平。在示踪剂注射后即刻（30 分钟）和延迟（4 小时）期获得 99mTc-sestamibi 心肌闪烁显像图像，以计算 AMI 发病后 2 周（0M）和 6 个月（6M）时的心脏与纵隔（H/M）比值和整体 WR，并计算罪犯病变的局部 WR（罪犯 WR）和心肌损伤的范围评分（ES）和严重程度评分（SS）。
AMI 发病后 8.3±7.7 小时进行 PCI。6 个月时，早期 H/M 比值（p=0.04）、延迟 H/M 比值（p=0.02）、整体 WR（p=0.01）、罪犯 WR（p=0.002）和延迟 ES（p=0.008）均有所缓解。在 0M 时，峰值 CK-MB 水平与延迟 H/M 比值（p=0.003）、整体 WR（p=0.003）、罪犯 WR（p<0.001）、早期 ES（p=0.03）、延迟 ES（p=0.01）、早期 SS（p=0.001）和延迟 SS（p<0.001）呈正相关。6 个月时，峰值 CK-MB 水平与延迟 H/M 比值（p<0.001）、整体 WR（p=0.005）、罪犯 WR（p=0.001）、早期 ES（p=0.001）、延迟 ES（p<0.001）、早期 SS（p<0.001）和延迟 SS（p<0.001）呈正相关。
这些结果表明，锝-99m sestamibi WR 在慢性期以及急性期均反映了 AMI 患者 PCI 后初始心肌损伤的范围。此外，它可能提示了心肌在临床过程中的情况。
