Schwaiger M, Brunken R C, Krivokapich J, Child J S, Tillisch J H, Phelps M E, Schelbert H R
Department of Radiological Sciences, UCLA School of Medicine 900224.
Eur Heart J. 1987 Sep;8(9):981-8. doi: 10.1093/oxfordjournals.eurheartj.a062375.
With the advent of therapeutic interventions to restore blood flow in patients with acute infarction, early identification of salvageable myocardium has gained clinical importance. It was the purpose of this study to define regional blood flow and glucose metabolism in patients with acute myocardial infarction as assessed by positron emission tomography (PET) and to correlate these findings with coronary anatomy. In 15 patients blood flow as determined by N-13 ammonia was reduced in 37 left ventricular segments. In 20 segments there was a similar decrease in FDG uptake, consistent with tissue necrosis. In contrast, 17 segments with reduced blood flow revealed maintained FDG uptake suggesting residual viability in the electrocardiographically defined 'infarct segment'. PET viability and necrosis was significantly associated with presence or absence of anterograde flow in the infarct artery. Evaluation of regional wall motion did not distinguish segments with PET criteria for viability from segments with necrosis. Thus, in patients without thrombolytic therapy during evolving myocardial infarction, spontaneous reperfusion appears to be beneficial for tissue survival. PET offers the unique possibility to assess tissue viability early after the ischaemic injury where evaluation of wall motion fails to identify salvageable myocardium.
随着恢复急性梗死患者血流的治疗干预措施的出现，早期识别可挽救的心肌具有重要的临床意义。本研究的目的是通过正电子发射断层扫描（PET）评估急性心肌梗死患者的局部血流和葡萄糖代谢，并将这些结果与冠状动脉解剖结构相关联。15例患者中，用N-13氨测定的血流在37个左心室节段中降低。在20个节段中，FDG摄取有类似降低，符合组织坏死。相反，17个血流降低的节段显示FDG摄取维持，提示在心电图定义的“梗死节段”中有残余存活心肌。PET显示的存活心肌和坏死与梗死动脉中有无顺行血流显著相关。对局部室壁运动的评估不能区分符合PET存活标准的节段和坏死节段。因此，在心肌梗死进展过程中未接受溶栓治疗的患者中，自发再灌注似乎对组织存活有益。PET提供了独特的可能性，可在缺血性损伤后早期评估组织存活情况，而此时对室壁运动的评估无法识别可挽救的心肌。
