Shiotani H, Yamabe H, Fukuzaki H
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Jpn Circ J. 1987 Sep;51(9):1016-21. doi: 10.1253/jcj.51.1016.
To clarify the clinical significance of regional myocardial perfusion abnormality of the left ventricle in dilated cardiomyopathy (DCM), 20 patients with DCM underwent dipyridamole Tl-201 emission computed tomography (ECT). The subjects were divided into 2 groups: group 1 had (n = 9) reversible defects and group 2 (n = 11) had persistent defects only. Group 2 patients significantly advanced heart failure and significantly poorer prognoses than group 1 (55% vs 11% in 2 years survival rate, p less than 0.05). The echocardiographic left ventricular end-diastolic dimension was larger in group 2 than group 1 (68.3 +/- 8.2 mm vs 61.9 +/- 4.0 mm, p less than 0.05) and % fractional shortening was smaller in group 2 than group 1 (18.0 +/- 4.5% vs 24.5 +/- 6.9%, p less than 0.05). Moreover, 12 of the 13 segments with reversible defect showed fairly well preserved left ventricular wall motion, whereas 35 of 58 segments with persistent defect had severely impaired wall motion (1/13 vs 35/58, p less than 0.01). Dipyridamole Tl-201 ECT demonstrated conclusively that the two types of defects (reversible and persistent) are useful to evaluate not only the abnormal myocardial perfusion but also myocardial damage and the prognosis in DCM.
为阐明扩张型心肌病（DCM）患者左心室局部心肌灌注异常的临床意义，对20例DCM患者进行了双嘧达莫铊-201发射计算机断层扫描（ECT）。研究对象分为两组：第1组（n = 9）有可逆性缺损，第2组（n = 11）仅有持续性缺损。第2组患者的心力衰竭进展明显，预后明显比第1组差（2年生存率分别为55%和11%，p<0.05）。第2组的超声心动图左心室舒张末期内径大于第1组（68.3±8.2mm对61.9±4.0mm，p<0.05），第2组的左心室短轴缩短率低于第1组（18.0±4.5%对24.5±6.9%，p<0.05）。此外，13个有可逆性缺损节段中的12个节段左心室壁运动保存相当良好，而58个有持续性缺损节段中的35个节段壁运动严重受损（1/13对35/58，p<0.01）。双嘧达莫铊-201 ECT确切表明，这两种类型的缺损（可逆性和持续性）不仅有助于评估DCM患者心肌灌注异常，还能评估心肌损伤及预后。
