Sharpe D N, Botvinick E H, Shames D M, Norman A, Chatterjee K, Parmley W W
Circulation. 1978 Feb;57(2):307-13. doi: 10.1161/01.cir.57.2.307.
We evaluated scintigraphic techniques in estimating infarct size. In 26 patients with acute transmural myocardial infarction, 99mTechnetium pyrophosphate (TcPYP) infarct scintigraphy, gated cardiac blood pool scintigraphy and 201-Thallium (201-Tl) perfusion scintigraphy were performed. Invasive hemodynamic measurements were obtained and serial venous blood specimens taken for measurement of total and MB creatine phosphokinase (CPK). In farct size was estimated from the area of abnormal TcPYP uptake, the extent of reduced 201-Tl uptake, the percentage of abnormally contracting segments, and serial enzyme measurements. Left ventricular ejection fraction (LVEF) and stroke work index (LVSWI) were calculated. TcPYP infarct area was associated with the extent of reduced 201-Tl uptake (r = 0.66), the percentage of abnormally contracting segments (r = 0.64), and with both LVSWI (r = 0.73) and LVEF (r = 0.58). TcPYP infarct area did not correlate with cumulative total or MB-CPK release or the integrated total CPK-time curve, nor did the enzyme estimates of infarct size correlate with LVSWI or LVEF. Variable perfusion of infarcts of different sizes may explain the lack of correlation between TcPYP infarct area and enzyme estimates of infarct size. A combination of anatomic and functional indices derived from scintigraphic and hemodynamic measurements may provide the best assessment of infarct size.
我们评估了闪烁扫描技术在估计梗死面积方面的作用。对26例急性透壁性心肌梗死患者进行了99m锝焦磷酸盐（TcPYP）梗死闪烁扫描、门控心血池闪烁扫描和铊-201（201-Tl）灌注闪烁扫描。进行了有创血流动力学测量，并采集系列静脉血标本以测定总肌酸磷酸激酶（CPK）和MB肌酸磷酸激酶。根据异常TcPYP摄取面积、201-Tl摄取减少的范围、异常收缩节段的百分比以及系列酶测量来估计梗死面积。计算左心室射血分数（LVEF）和每搏功指数（LVSWI）。TcPYP梗死面积与201-Tl摄取减少的范围（r = 0.66）、异常收缩节段的百分比（r = 0.64）以及LVSWI（r = 0.73）和LVEF（r = 0.58）均相关。TcPYP梗死面积与累积总CPK或MB-CPK释放量或总CPK-时间积分曲线均无相关性，梗死面积的酶学估计值与LVSWI或LVEF也无相关性。不同大小梗死灶的灌注差异可能解释了TcPYP梗死面积与梗死面积的酶学估计值之间缺乏相关性的原因。结合闪烁扫描和血流动力学测量得出的解剖学和功能指标可能会对梗死面积做出最佳评估。
