Dunn R F, Uren R F, Sadick N, Bautovich G, McLaughlin A, Hiroe M, Kelly D T
Circulation. 1982 Oct;66(4):804-10. doi: 10.1161/01.cir.66.4.804.
To determine whether cardiomyopathy could be distinguished from coronary artery disease, we used thallium scanning to study 25 patients with severe left ventricular dysfunction and chronic heart failure. Ten patients had normal coronary arteries and idiopathic cardiomyopathy (ejection fraction 20 +/- 5%), and 15 patients had multivessel coronary disease and left ventricular dysfunction (ejection fraction 25 +/- 6%). The exercise time and maximal heart rate were similar in the two groups. Two patients with cardiomyopathy and 11 with coronary artery disease had a positive exercise ECG (p less than 0.05). Thallium scans showed perfusion defects in all 25 patients. The perfusion defects were complete in nine coronary artery disease patients (60%) and in one patient (10%) with cardiomyopathy (p less than 0.05). Extensive defects involving more than 40% of the left ventricular circumference, the number of segments involved, redistribution on the 4-hour scan, lung uptake and ventricular size were similar in the two groups. Perfusion defects on thallium scanning can occur in patients with idiopathic dilated cardiomyopathy and chronic heart failure. Thallium scanning cannot be reliably used in patients with chronic heart failure to distinguish coronary artery disease from cardiomyopathy unless complete defects are present.
为了确定心肌病是否能与冠状动脉疾病相鉴别，我们采用铊扫描研究了25例严重左心室功能障碍和慢性心力衰竭患者。10例患者冠状动脉正常，患有特发性心肌病（射血分数20±5%），15例患者有多支冠状动脉疾病和左心室功能障碍（射血分数25±6%）。两组患者的运动时间和最大心率相似。2例心肌病患者和11例冠状动脉疾病患者运动心电图呈阳性（p<0.05）。铊扫描显示所有25例患者均有灌注缺损。9例（60%）冠状动脉疾病患者和1例（10%）心肌病患者的灌注缺损为完全性（p<0.05）。两组患者累及左心室圆周超过40%的广泛缺损、受累节段数、4小时扫描时的再分布、肺部摄取及心室大小相似。特发性扩张型心肌病和慢性心力衰竭患者铊扫描可出现灌注缺损。除非存在完全性缺损，铊扫描不能可靠地用于慢性心力衰竭患者以鉴别冠状动脉疾病和心肌病。
