Nomura Tetsuya, Kusaba Tetsuro, Kodama Naotoshi, Terada Kensuke, Urakabe Yota, Nishikawa Susumu, Keira Natsuya, Matsubara Hiroaki, Tatsumi Tetsuya
Department of Cardiovascular Medicine, Nantan General Hospital, 25 Yagi-Ueno, Yagi-cho, Nantan, Kyoto, Japan.
Heart Vessels. 2013 Jan;28(1):27-33. doi: 10.1007/s00380-011-0210-9. Epub 2011 Nov 29.
It is well known that silent myocardial ischemia (SMI) often complicates patients with cerebral infarction and that stroke patients often die of ischemic heart disease. Therefore, it is considered important to treat myocardial ischemia in stroke patients. This study investigated SMI complicating Japanese patients with fresh stroke, using (99m)Tc-tetrofosmin myocardial scintigraphy with pharmacologic stress testing to elucidate their clinical manifestations. This study included 41 patients (26 men, mean age 76.0 ± 10.7 years) with acute cerebral infarction and no history of coronary artery disease. All patients underwent (99m)Tc-tetrofosmin myocardial scintigraphy with intravenous administration of adenosine to diagnose SMI. Of the 41 patients, myocardial ischemia was confirmed in 17 patients (41.5%). Atherosclerotic etiology was the major cause of stroke in the ischemia(+) group and embolic origin was the major cause in the ischemia(-) group. Patients with myocardial ischemia had a higher incidence of diabetes mellitus (52.9 vs 20.8%; P = 0.0323) and more than two conventional cardiovascular risk factors (64.7 vs 25.0%; P = 0.0110) compared with the nonischemic patients. Infarction subtype of atherosclerotic origin was an independent positive predictor of asymptomatic myocardial ischemia in patients with stroke. These findings indicate that the prevalence of asymptomatic myocardial ischemia is relatively high, especially in patients with stroke of atherosclerotic origin. Therefore, it is beneficial for us to narrow the target population who are at the highest risk when screening for SMI in Japanese patients with acute cerebral infarction.
众所周知，无症状心肌缺血（SMI）常使脑梗死患者病情复杂化，且卒中患者常死于缺血性心脏病。因此，治疗卒中患者的心肌缺血被认为很重要。本研究采用（99m）锝-替曲膦心肌闪烁显像及药物负荷试验，对合并SMI的日本急性卒中患者进行调查，以阐明其临床表现。本研究纳入41例（26例男性，平均年龄76.0±10.7岁）急性脑梗死且无冠状动脉疾病史的患者。所有患者均接受静脉注射腺苷的（99m）锝-替曲膦心肌闪烁显像以诊断SMI。41例患者中，17例（41.5%）确诊为心肌缺血。缺血（+）组中动脉粥样硬化病因是卒中的主要原因，而缺血（-）组中栓子来源是主要原因。与非缺血患者相比，心肌缺血患者糖尿病发病率更高（52.9%对20.8%；P = 0.0323），且有两种以上传统心血管危险因素的比例更高（64.7%对25.0%；P = 0.0110）。动脉粥样硬化起源的梗死亚型是卒中患者无症状心肌缺血的独立阳性预测因子。这些发现表明，无症状心肌缺血的患病率相对较高，尤其是在动脉粥样硬化起源的卒中患者中。因此，对于我们来说，在筛查日本急性脑梗死患者的SMI时缩小高危目标人群范围是有益的。
