Verani M S, Tadros S, Raizner A E, Phillips R, Matcek G, Lewis J M, Roberts R
Int J Cardiol. 1986 Nov;13(2):109-24. doi: 10.1016/0167-5273(86)90136-1.
Transluminal coronary angioplasty has become an important therapeutic modality in the treatment of coronary artery disease. The effects of coronary angioplasty on regional myocardial perfusion have been reported in only a small series of patients, employing subjective analysis of thallium-201 perfusion scintigrams. Thus, we studied 61 patients with quantitative analysis of thallium-201 uptake and washout before and after undergoing angioplasty. Prior to angioplasty, there were 105 areas in 47 patients with abnormal thallium-201 uptake during exercise, with a mean uptake of 49 +/- 1.3%. The uptake of thallium-201 in these same areas increased to 71.3 +/- 1.9% post angioplasty (P less than 0.0001), and 68 (65%) of the areas showing abnormal uptake returned to normal. Abnormalities in washout of thallium-201 before angioplasty were seen more frequently than in uptake (150 vs 105 areas, P less than 0.05), with 8 patients having abnormal washout in the presence of totally normal uptake. Thallium-201 washout in the abnormal areas improved from 16 +/- 2.8 pre angioplasty to -23 +/- 1.8% post angioplasty (P less than 0.001). Normalization resulted in 6 of the 8 patients with exclusively washout abnormality. Residual abnormalities in uptake and/or washout were seen in 53% of the patients, usually in areas with prior myocardial infarction or supplied by a vessel with significant stenosis which did not undergo angioplasty. Improved thallium-201 uptake and washout corresponded to reductions in percent coronary area stenosis (89 +/- 1.0 to 36 +/- 2.0%, P less than 0.001) and transstenotic pressure gradient (42 +/- 3.0 to 9.0 +/- 2.0 mm Hg, P less than 0.001). Thus, quantitative analysis of thallium-201 uptake and washout provided objective evidence for improved myocardial perfusion after coronary angioplasty. Due to a fairly high prevalence of residual perfusion abnormalities after this procedure, optimal assessment of benefits requires quantitative comparison of thallium uptake and washout before and after coronary angioplasty.
经腔冠状动脉血管成形术已成为治疗冠状动脉疾病的一种重要治疗方式。关于冠状动脉血管成形术对局部心肌灌注的影响，仅在一小部分患者中进行过报道，采用的是对铊-201灌注闪烁图的主观分析。因此，我们对61例患者在血管成形术前后进行了铊-201摄取和洗脱的定量分析研究。在血管成形术前，47例患者在运动时有105个区域铊-201摄取异常，平均摄取率为49±1.3%。这些相同区域的铊-201摄取在血管成形术后增加到71.3±1.9%（P＜0.0001），并且68个（65%）显示摄取异常的区域恢复正常。血管成形术前铊-201洗脱异常比摄取异常更常见（150个区域对105个区域，P＜0.05），有8例患者在摄取完全正常的情况下洗脱异常。异常区域的铊-201洗脱从血管成形术前的16±2.8%改善到血管成形术后的-23±1.8%（P＜0.001）。8例仅洗脱异常的患者中有6例恢复正常。53%的患者存在摄取和/或洗脱的残余异常，通常在既往有心肌梗死的区域或由未进行血管成形术的严重狭窄血管供血的区域。铊-201摄取和洗脱的改善与冠状动脉狭窄百分比的降低（89±1.0%至36±2.0%，P＜0.001）和跨狭窄压力梯度的降低（42±3.0至9.0±2.0 mmHg，P＜0.001）相对应。因此，铊-201摄取和洗脱的定量分析为冠状动脉血管成形术后心肌灌注改善提供了客观证据。由于该手术后残余灌注异常的发生率相当高，对益处的最佳评估需要对冠状动脉血管成形术前后的铊摄取和洗脱进行定量比较。
