Peymani Zeinab, Tafakhori Abbas, Farzanehfar Saeed, Larti Farnoosh, Hosseini Ali, Abbasi Mehrshad
Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Asia Ocean J Nucl Med Biol. 2023;11(2):122-127. doi: 10.22038/AOJNMB.2023.67084.1465.
The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use , may contribute to higher CAD risk.In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate.
Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal.
Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12). In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014).
MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD.
使用抗癫痫药物（AED）的癫痫患者中冠状动脉疾病（CAD）的患病率较高。癫痫、AED或AED使用的类型和持续时间可能导致CAD风险升高。在本研究中，对使用卡马西平和丙戊酸盐的患者进行了心肌灌注成像（MPI）比较。
在一家三级转诊诊所就诊的73例接受卡马西平或丙戊酸单药治疗超过2年的患者中，32例患者参与了为期2天的负荷及静息期MPI检查。在负荷期，于运动高峰或通过药物刺激注射15 - 25 mCi的99mTc - MIBI。使用双头伽马相机进行门控心脏单光子发射计算机断层扫描（SPECT），并进行处理和定量分析。扫描结果中至少有一个明确的可逆性灌注减低节段被视为异常。
17例患者接受卡马西平单药治疗，15例接受丙戊酸治疗。两组患者的年龄和AED使用时间相似。丙戊酸组有2例扫描结果异常（6.3%），卡马西平组有2例（13.3%）。扫描结果异常的患者AED使用时间更长。在接受单药治疗超过2年的患者中，两组间MPI异常频率相似（P值 = 0.12）。在接受单药治疗超过5年的患者中，丙戊酸组MPI异常患病率更高（28.6%对0.0%；P值 = 0.042）。在丙戊酸亚组中，与正常患者相比，缺血患者的AED使用时间更长（17.0±4.2对6.4±4.8，P值 = 0.014）。
与接受卡马西平治疗的患者相比，接受丙戊酸治疗5年后的患者MPI结果异常。长期使用丙戊酸可能增加CAD风险。
