Tillmanns H, Zimmermann R, Kapp M, Rauch B, Neumann F J, Schlumpp K, Bubeck B, Georgi P, Kübler W
Med. Univ.-Klinik, Abt. Inn. Med. III, Universität Heidelberg.
Z Kardiol. 1989;78 Suppl 5:77-82.
Numerous experimental and clinical studies indicated that in the presence of coronary artery stenoses, myocardial thallium-201 and free fatty acid uptake in poststenotic regions is reduced during exercise. The aim of this study was to investigate the effect of the calcium antagonist gallopamil on myocardial thallium-201 and free fatty acid uptake in patients suffering from coronary artery disease. In 6 patients with angiographically proven coronary artery disease--2 patients with 1-vessel, 2 patients with 2-vessel and 2 patients with 3-vessel disease--as well as good left ventricular performance and stable, exerciseinduced angina, quantitative double-tracer scintigraphy was performed. Patients were investigated after a placebo period of 1 week, after oral gallopamil medication for 4 weeks (3 X 50 mg gallopamil daily), and after a double-blind period of 1 week. During symptom-limited exercise, 2 mCi thallium-201 and 5 mCi iodine-123 phenyl-pentadecanoic acid (IPPA) were simultaneously injected intravenously. Immediately after exercise, as well as 1 and 4 hours later, planar images were obtained in ap, 30 degrees LAO and 60 degrees LAO projections. By means of a newly developed computer algorithm, global and regional myocardial tracer uptake as well as IPPA clearance were evaluated. - Gallopamil provoked a decrease of global myocardial thallium-201 and IPPA uptake due to a reduction of myocardial oxygen consumption. Regional thallium-201 and IPPA uptake as well as myocardial IPPA clearance in poststenotic areas tended to rise following gallopamil medication. Thus, in the presence of coronary artery disease, gallopamil provokes an improvement of regional perfusion (dilatation of larger coronary arterioles) as well as an enhanced free fatty acid utilization in reversibly ischemic myocardial regions.
大量实验和临床研究表明，在存在冠状动脉狭窄的情况下，运动期间狭窄后区域的心肌铊-201摄取和游离脂肪酸摄取会减少。本研究的目的是调查钙拮抗剂加洛帕米对冠心病患者心肌铊-201摄取和游离脂肪酸摄取的影响。对6例经血管造影证实患有冠心病的患者——2例单支血管病变、2例双支血管病变和2例三支血管病变患者——以及左心室功能良好且患有稳定的运动诱发型心绞痛的患者进行了定量双示踪剂闪烁显像检查。患者在经过1周的安慰剂期、口服加洛帕米4周（每日3次，每次50 mg加洛帕米）后以及经过1周的双盲期后接受检查。在症状限制运动期间，静脉内同时注射2 mCi铊-201和5 mCi碘-123苯基十五烷酸（IPPA）。运动后即刻以及1小时和4小时后，分别在前后位、左前斜30度和左前斜60度投影下获取平面图像。通过一种新开发的计算机算法，评估了整体和局部心肌示踪剂摄取以及IPPA清除情况。加洛帕米由于心肌耗氧量降低，导致整体心肌铊-201和IPPA摄取减少。加洛帕米用药后，狭窄后区域的局部铊-201和IPPA摄取以及心肌IPPA清除率有升高趋势。因此，在存在冠心病的情况下，加洛帕米可改善局部灌注（扩张较大的冠状动脉小动脉），并提高可逆性缺血心肌区域的游离脂肪酸利用率。
