Shibata Yohei, Sone Takahito, Tsuboi Hideyuki, Isobe Satoshi, Ishii Hideki, Suzuki Susumu, Hayashi Mutsuharu, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):155-66.
The cutoff values of fractional flow reserve (FFR) to detect physiological myocardial ischemia are still controversial. Some studies have reported that left ventricular (LV) dyssynchrony occurs in patients with coronary artery disease (CAD). The purpose of this study was to investigate LV dyssynchrony in patients with moderate coronary stenosis and borderline FFR, using stress electrocardiographically-gated myocardial perfusion single-photon emission computed tomography (SPECT). The study population comprised 10 patients with moderate (50-75% diameter) stenosis and an FFR in the range 0.75-0.90, who were compared to 10 control subjects. All underwent stress myocardial (99m)Tc-sestamibi (MIBI) or tetrofosmin SPECT imaging. The regional time to end systole (TES), time to peak ejection (TPE), and time to peak filling (TPF) were obtained as indexes of perfusion and function, using gated SPECT (pFAST) in combination with Cardio Gated SPECT Regional Assessment for LV Function (cardioGRAF). The dyssynchrony index (DI) was also calculated. The DI of post-stress TES was significantly greater than that of rest in patients with moderate CAD (4.8 ± 2.8 vs. 2.7 ± 1.5, P = 0.01), but there were no significant differences in the control subjects (3.0 ± 1.7 vs. 2.9 ± 1.9, P = 0.99). There were no significant differences in TPE and TPF between the groups. In conclusion, LV dyssynchrony may occur after stress in patients with coronary stenosis and borderline FFR, even without a significant reduction in perfusion.
用于检测生理性心肌缺血的血流储备分数（FFR）的临界值仍存在争议。一些研究报告称，冠状动脉疾病（CAD）患者会出现左心室（LV）不同步。本研究的目的是使用应力心电图门控心肌灌注单光子发射计算机断层扫描（SPECT），调查中度冠状动脉狭窄和临界FFR患者的LV不同步情况。研究人群包括10例中度（直径50 - 75%）狭窄且FFR在0.75 - 0.90范围内的患者，将其与10名对照受试者进行比较。所有受试者均接受了应力心肌（99m）锝 - sestamibi（MIBI）或替曲膦SPECT成像。使用门控SPECT（pFAST）结合用于左心室功能的心脏门控SPECT区域评估（cardioGRAF），获取区域收缩末期时间（TES）、射血峰值时间（TPE）和充盈峰值时间（TPF）作为灌注和功能指标。还计算了不同步指数（DI）。中度CAD患者应力后TES的DI显著高于静息时（4.8±2.8 vs. 2.7±1.5，P = 0.01），但对照受试者无显著差异（3.0±1.7 vs. 2.9±1.9，P = 0.99）。两组之间的TPE和TPF无显著差异。总之，冠状动脉狭窄和临界FFR患者在应激后可能会出现LV不同步，即使灌注没有显著降低。
