Gallik D M, Obermueller S D, Swarna U S, Guidry G W, Mahmarian J J, Verani M S
Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Coll Cardiol. 1995 Jun;25(7):1529-38. doi: 10.1016/0735-1097(95)00092-i.
We used technetium-99m sestamibi imaging to evaluate the magnitude of changes in left ventricular function and perfusion and to investigate their interdependence during transient coronary occlusion.
Transient coronary occlusion during coronary angioplasty provides a unique opportunity for examining the effects of acute myocardial ischemia on left ventricular function and perfusion.
Thirty-five patients with normal left ventricular function underwent first-pass radionuclide angiography with technetium-99m sestamibi using a multicrystal gamma camera during balloon occlusion of a coronary artery. Single-photon tomography was performed 2.1 +/- 1.7 h later. Subsequently, all scans were repeated at rest.
The mean size +/- SD of the perfusion defect during coronary occlusion was 23 +/- 18%, with significantly larger defects observed for occlusions of the left anterior descending coronary artery (39 +/- 20%) than for occlusions of the left circumflex (15 +/- 11%) or right (15 +/- 9%) coronary artery (p < 0.05). The mean change in ejection fraction from recovery to occlusion was -17 +/- 17% and was significantly larger for left anterior descending (-26 +/- 21%) and left circumflex (-15 +/- 11%) than for right (-8 +/- 10%) coronary artery occlusions (p < 0.05). For the entire group, ejection fraction during occlusion correlated significantly with perfusion defect size (r = 0.63, p = 0.0004), whereas the extent of ischemic myocardium correlated with the decrease in ejection fraction (r = 0.69, p = 0.0001). The defects present during occlusion reversed within a few hours.
Changes in left ventricular function and perfusion develop pari passu during coronary occlusion and are more severe when the left anterior descending artery is occluded. Although a significant correlation exists between the extent of the perfusion defect and the severity of the decrease in ejection fraction, there is a substantial individual variation with respect to changes in both myocardial perfusion and ventricular function during acute coronary occlusion.
我们使用锝-99m 甲氧基异丁基异腈显像来评估左心室功能和灌注的变化程度，并研究在短暂冠状动脉闭塞期间它们之间的相互依赖性。
冠状动脉血管成形术期间的短暂冠状动脉闭塞为研究急性心肌缺血对左心室功能和灌注的影响提供了独特的机会。
35 例左心室功能正常的患者在冠状动脉球囊闭塞期间使用多晶体γ相机进行了锝-99m 甲氧基异丁基异腈首次通过放射性核素血管造影。2.1±1.7 小时后进行单光子断层扫描。随后，所有扫描在静息状态下重复进行。
冠状动脉闭塞期间灌注缺损的平均大小±标准差为 23±18%，左前降支冠状动脉闭塞时观察到的缺损（39±20%）明显大于左旋支（15±11%）或右冠状动脉（15±9%）闭塞时的缺损（p<0.05）。从恢复到闭塞射血分数的平均变化为-17±17%，左前降支（-26±21%）和左旋支（-15±11%）闭塞时的变化明显大于右冠状动脉（-8±10%）闭塞时的变化（p<0.05）。对于整个组，闭塞期间的射血分数与灌注缺损大小显著相关（r = 0.63，p = 0.0004），而缺血心肌的范围与射血分数的降低相关（r = 0.69，p = 0.0001）。闭塞期间出现的缺损在数小时内逆转。
冠状动脉闭塞期间左心室功能和灌注的变化同步发生，当左前降支动脉闭塞时变化更严重。虽然灌注缺损的程度与射血分数降低的严重程度之间存在显著相关性，但在急性冠状动脉闭塞期间，心肌灌注和心室功能的变化存在很大的个体差异。
