Ando J, Yasuda H, Koya T, Matsumura N, Kojima S, Miyamoto A, Kanamori K, Kobayashi T
Jpn Heart J. 1985 Mar;26(2):179-89. doi: 10.1536/ihj.26.179.
In order to determine whether painless ST changes represent myocardial ischemia, we studied regional myocardial perfusion in patients with angina pectoris who showed painless ST-segment depression during a treadmill exercise test. Twenty-one patients were evaluated by myocardial imaging using thallium-201 injected intravenously during exercise when painless ST-segment depression was evident. The same examination was repeated in 5 of the above patients when they showed ST-segment depression with chest pain. Myocardial images obtained during painless ST-segment depression revealed perfusion defects in 15 of 21 patients (71%). Images obtained during ST-segment depression with chest pain showed perfusion defects in all 5 patients (100%) including 3 patients who demonstrated no defects during painless ST-segment depression. In these 5 patients, the ST-segment depression associated with pain was significantly greater than that without pain (3.4 +/- 1.1 vs 2.1 +/- 1.1 mm, p less than 0.01). These results suggest that the majority of episodes of painless ST-segment depression occurring during exercise are accompanied by regional myocardial perfusion abnormalities and that transient painless ST-segment depression in patients with angina pectoris might represent less severe myocardial ischemia.
为了确定无痛性ST段改变是否代表心肌缺血，我们对在平板运动试验中出现无痛性ST段压低的心绞痛患者的局部心肌灌注情况进行了研究。21例患者在运动时出现明显无痛性ST段压低时，通过静脉注射铊-201进行心肌显像评估。上述5例患者在出现胸痛伴ST段压低时重复进行了相同检查。无痛性ST段压低时获得的心肌图像显示，21例患者中有15例（71%）存在灌注缺损。胸痛伴ST段压低时获得的图像显示，所有5例患者（100%）均存在灌注缺损，其中3例在无痛性ST段压低时未显示缺损。在这5例患者中，与疼痛相关的ST段压低明显大于无痛时的ST段压低（3.4±1.1对2.1±1.1mm，p<0.01）。这些结果表明，运动期间发生的大多数无痛性ST段压低发作伴有局部心肌灌注异常，并且心绞痛患者的短暂无痛性ST段压低可能代表不太严重的心肌缺血。
