Saltissi S, Robinson P S, Webb-Peploe M M, Coltart D J, Croft D N
Br Heart J. 1981 Feb;45(2):173-80. doi: 10.1136/hrt.45.2.173.
Infarct size was estimated by cumulative creatine kinase MB isoenzyme (CKMB-r) release and by technetium 99m stannous pyrophosphate (TcPYP) scintigraphy in 27 patients with acute anterior myocardial infarction. In eight patients, scintigraphy showed a central area of reduced tracer uptake surrounded by a peripheral rim of increased TcPYP accumulation ("doughnut" pattern). This appearance occurred only in large infarcts and the maximal scintigraphic area (51.3 +/- 2.8 cm2, mean +/- SEM) in this group was significantly greater than that in the remainder (28.1 +/- 2.5 cm2). Correlation between CKMB-r and maximal scintigraphic infarct area was moderate in the whole group. Exclusion of patients, however, with "doughnut" scintigrams in which correlation was very poor, resulted in substantial improvement in the remainder. It is suggested that in the central regions of large "doughnut" infarcts, reduced blood flow hinders the efflux of CKMB from the centre causing an underestimate of infarct size. Pyrophosphate scintigraphy appears to be more accurate than CKMB release in measuring the size of these large anterior infarcts.
采用累积肌酸激酶MB同工酶（CKMB-r）释放量及锝99m焦磷酸亚锡（TcPYP）闪烁扫描法对27例急性前壁心肌梗死患者的梗死面积进行了评估。8例患者的闪烁扫描显示，放射性示踪剂摄取减少的中央区域被TcPYP蓄积增加的外周边缘所包围（“甜甜圈”样模式）。这种表现仅见于大面积梗死，该组的最大闪烁扫描面积（51.3±2.8 cm²，均值±标准误）显著大于其余患者（28.1±2.5 cm²）。在整个研究组中，CKMB-r与最大闪烁扫描梗死面积之间的相关性为中等程度。然而，排除“甜甜圈”样闪烁扫描图像的患者（其相关性非常差）后，其余患者的相关性有显著改善。提示在大面积“甜甜圈”样梗死的中央区域，血流减少阻碍了CKMB从梗死中心的流出，导致梗死面积被低估。在测量这些大面积前壁梗死的面积时，焦磷酸闪烁扫描法似乎比CKMB释放法更准确。
