Tanaka T, Aizawa T, Katou K, Ogasawara K, Kirigaya H, Okamoto K
Cardiovascular Institute, Tokyo, Japan.
Kaku Igaku. 1990 Nov;27(11):1247-53.
Myocardial viability after PTCR in patients with first anterior myocardial infarction was studied one month after the onset of acute myocardial infarction by profile curve of Tl-201 coronal myocardial SPECT images. Patients were devided into two groups according to left ventricular ejection fraction (EF), i.e. group A (EF more than 50%; 11 cases , EF; 62 +/- 10%) and group B (EF less than 50%; 9 cases, EF; 40 7%). Patients in group A showed an increase in serum GOT at the acute phase of acute myocardial infarction (322 +/- 182IU), decreased %Tl-201 uptake in QS region (65 +/- 7%) significantly less than the normal range, large size of region of infarction (214 +/- 83 degree) and abnormal QS in ECG (V1-3QS; 2 cases, V1-4QS; 8 cases, V1-5QS; 1 case). Improvement of wall motion in region of infarction was noted in 9 cases. Patients in group B showed an increase in serum GOT (651 +/- 382 IU p; ns), %Tl-201 uptake in QS region (48 +/- 7% p greater than 0.001) significantly less than the %Tl-201 uptake in group A, size of defects (243 +/- 45 p; ns) and abnormal QS in ECG (V1-3QS; 1 case, V1-4QS; 7 cases V1-5QS; 1 case). Improvement of wall motion was noted in 2 cases. The study showed that %Tl-201 uptake in region of infarction in patients with well EF was significantly more than that in patients with depressed EF. Mechanism of maintaining well EF after PTCR was suggested as the following, i.e. in the region released from severe ischemic attack part of myocardium resulted in necrosis, accompanying elevation of serum enzyme and appearance of QS, though part of myocardium might be salvaged from necrosis and contribute to EF in chronic phase. It has been generally thought that abnormal QS waves noted in anterior chest leads of ECG in chronic phase indicated transmural myocardial infarction in the anterior region. From this study it was concluded that QS region with %Tl-201 more than 50% did not generally correspond to transmural myocardial necrosis and that for estimation of myocardial viability %Tl-201 uptake might be more useful than ECG.
在首次前壁心肌梗死患者中，于急性心肌梗死发病1个月后，通过铊-201冠状心肌单光子发射计算机断层扫描（SPECT）图像的轮廓曲线研究经皮冠状动脉腔内血管成形术（PTCR）后的心肌存活性。根据左心室射血分数（EF）将患者分为两组，即A组（EF大于50%；11例，EF为62±10%）和B组（EF小于50%；9例，EF为40±7%）。A组患者在急性心肌梗死急性期血清谷草转氨酶（GOT）升高（322±182IU），梗死相关区域铊-201摄取百分比降低（65±7%），明显低于正常范围，梗死区域大（214±83度），心电图出现异常QS波（V1-3QS；2例，V1-4QS；8例，V1-5QS；1例）。梗死区域室壁运动改善者9例。B组患者血清GOT升高（651±382IU，P值无统计学意义），梗死相关区域铊-201摄取百分比（48±7%，P值大于0.001）明显低于A组，缺损大小（243±45，P值无统计学意义），心电图出现异常QS波（V1-3QS；1例，V1-4QS；7例，V1-5QS；1例）。室壁运动改善者2例。研究表明，EF正常患者梗死区域的铊-201摄取明显多于EF降低患者。PTCR后维持良好EF的机制如下，即在严重缺血发作解除的区域，部分心肌发生坏死，伴有血清酶升高和QS波出现，尽管部分心肌可能从坏死中挽救出来并在慢性期对EF有贡献。一般认为，慢性期心电图前胸导联出现的异常QS波提示前壁透壁性心肌梗死。从本研究得出结论，铊-201摄取百分比大于50%的QS区域一般不对应透壁性心肌坏死，对于评估心肌存活性，铊-201摄取可能比心电图更有用。
