Kureshi S A, Tamaki N, Yonekura Y, Koide H, Konishi Y, Ban T, Konishi J, Torizuka K
Department of Nuclear Medicine, Kyoto University Faculty of Medicine, Japan.
Jpn Heart J. 1989 May;30(3):287-99. doi: 10.1536/ihj.30.287.
To examine the value of stress and redistribution thallium-201 single photon emission computed tomography (SPECT) for predicting improvement after coronary artery bypass grafting (CABG) and for assessing graft patency, 17 patients underwent SPECT before and after CABG. Preoperatively, 16 patients (94%) showed reversible ischemia with redistribution, and defect score decreased from 16.4 +/- 7.6 to 8.3 +/- 5.8 (p less than 0.001) on 2 hour delayed images. Stress electrocardiography was positive in 15 cases (88%). The stress defect score was reduced postoperatively (7.8 +/- 6.3) as compared to the preoperative score (16.4 +/- 7.6) (p less than 0.001). Postoperatively, 7 cases (41%) showed reversible ischemia and the defect score decreased from 11.3 +/- 6.5 to 6.1 +/- 4.7 (p less than 0.05), while 4 cases (23.5%) showed positive stress electrocardiograms (ECG). Resting left ventricular (LV) ejection fraction (EF) improved in 6 cases (48.3 +/- 5.4% preoperatively to 56.8 +/- 7.4% postoperatively, p less than 0.05) and showed a reduction in 11 (58.2 +/- 10.5% to 47.5 +/- 9.4%, p less than 0.01). Grafts were occluded in 6 cases, and redistribution was evident on the delayed thallium images in all cases (100%), while stress ECG was positive in only 3 (50%). Thus, stress and redistribution SPECT is valuable for identifying patients who will improve after surgery and assessing graft patency more accurately than stress ECG. Resting LVEF was less useful for assessing improvement in LV function.
为了研究应激及再分布铊-201单光子发射计算机断层扫描（SPECT）在预测冠状动脉旁路移植术（CABG）后病情改善及评估移植血管通畅性方面的价值，对17例患者在CABG术前和术后进行了SPECT检查。术前，16例患者（94%）表现为再分布的可逆性缺血，延迟2小时图像上的缺损评分从16.4±7.6降至8.3±5.8（p<0.001）。15例患者（88%）应激心电图呈阳性。术后应激缺损评分（7.8±6.3）较术前评分（16.4±7.6）降低（p<0.001）。术后，7例患者（41%）表现为可逆性缺血，缺损评分从11.3±6.5降至6.1±4.7（p<0.05），而4例患者（23.5%）应激心电图呈阳性。静息左心室（LV）射血分数（EF）在6例患者中得到改善（术前为48.3±5.4%，术后为56.8±7.4%，p<0.05），在11例患者中降低（从58.2±10.5%降至47.5±9.4%，p<0.01）。6例移植血管闭塞，所有病例（100%）延迟铊图像上均可见再分布，而应激心电图仅3例（50%）呈阳性。因此，应激及再分布SPECT在识别术后病情改善的患者及评估移植血管通畅性方面比应激心电图更有价值。静息LVEF在评估左心室功能改善方面作用较小。
