Kanoh Y, Ohnishi M, Mori T, Shiotani H, Ohmori Y, Yokota Y, Fukuzaki H, Maeda K
First Department of Internal Medicine, Kobe University School of Medicine.
J Cardiol. 1987 Mar;17(1):47-55.
The present study clarified the relationship between wall motion and myocardial flow in dilated cardiomyopathy (DCM). Two-dimensional echocardiography (2-DE) was performed in 14 patients before and after dobutamine (DOB) drip infusion (8 micrograms/kg/min). Thallium-201 emission computed tomography (ECT) was performed after dobutamine infusion and three hours thereafter. The left ventricle was divided into nine segments. In each segment, the degrees of defects were scored from 0 (normal) to 3 (complete defect), and the severity of wall motion abnormalities was scored from 0 (normal) to 3 (akinesis) by visual inspection. 1. Perfusion defects on ECT images were observed during dobutamine infusion in all patients. Redistribution was observed in nine of 14 (64%) patients. 2. During infusion, 38 (81%) of 47 segments without defects showed normal wall motion, but 44 (86%) of 51 segments with defects showed wall motion abnormalities. 3. Redistribution was observed in 18 (35%) of 51 segments, and these segments showed lower incidence of wall motion abnormalities as compared to the other segments (94% vs 45%, p less than 0.001). 4. After infusion, the segments with redistribution frequently showed improved wall motion as compared to the other segments (56% vs 18%, p less than 0.05). These results indicate that redistribution on the ECT image is observed in some patients with dilated cardiomyopathy after dobutamine administration. This may be due to the capacity of the drug to increase myocardial flow in proportion to the increase of oxygen demand.
本研究阐明了扩张型心肌病（DCM）中室壁运动与心肌血流之间的关系。对14例患者在多巴酚丁胺（DOB）静脉滴注（8微克/千克/分钟）前后进行了二维超声心动图（2-DE）检查。在多巴酚丁胺输注后及此后三小时进行了铊-201发射计算机断层扫描（ECT）。左心室被分为九个节段。在每个节段中，缺损程度从0（正常）到3（完全缺损）进行评分，通过视觉检查将室壁运动异常的严重程度从0（正常）到3（运动不能）进行评分。1. 所有患者在多巴酚丁胺输注期间均观察到ECT图像上的灌注缺损。14例患者中有9例（64%）观察到了再分布。2. 在输注期间，47个无缺损节段中有38个（81%）显示室壁运动正常，但51个有缺损节段中有44个（86%）显示室壁运动异常。3. 在51个节段中有18个（35%）观察到了再分布，与其他节段相比，这些节段室壁运动异常的发生率较低（94%对45%，p<0.001）。4. 输注后，与其他节段相比，有再分布的节段室壁运动经常改善（56%对18%，p<0.05）。这些结果表明，在扩张型心肌病患者中，多巴酚丁胺给药后，部分患者的ECT图像上可观察到再分布。这可能是由于该药物能够使心肌血流随氧需求的增加而成比例增加。
