Lomboy C T, Schulman D S, Grill H P, Flores A R, Orie J E, Granato J E
Department of Internal Medicine, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburg 15212.
J Am Coll Cardiol. 1995 Jan;25(1):210-7. doi: 10.1016/0735-1097(94)00350-y.
This study attempted to determine the utility of early rest-redistribution thallium-201 imaging in detecting residual myocardial viability after myocardial infarction.
The early detection of myocardial viability after myocardial infarction would have clinical relevance.
Thirty-one patients with acute myocardial infarction had early (mean [+/- SD] 2 +/- 1 day) rest-redistribution thallium-201 imaging followed by radionuclide and coronary angiography. Late studies included stress-redistribution-reinjection thallium-201 imaging or radionuclide angiography, or both. Viability was defined by the rest thallium-201 scan as an initial mild rest defect or any defect that demonstrated redistribution.
Group 1 (n = 15) was predicted to have viable and Group 2 (n = 16) nonviable myocardium in the infarct zone. Group 1 patients were more likely to have a patent infarct-related artery (15 of 15 vs. 10 of 16, p < 0.03), higher initial ejection fraction (61 +/- 12% vs. 53 +/- 9%, p < 0.05), higher infarct wall motion score (p < 0.0001) and fewer abnormal thallium-201 segments (p < 0.0001). On follow-up studies, ejection fraction improved in Group 1 (from 57 +/- 13% to 66 +/- 10%, p < 0.05, n = 9) and deteriorated in Group 2 (from 53 +/- 10% to 46 +/- 8%, p < 0.05, n = 13). On late stress testing with thallium-201 reinjection, Group 1 patients had fewer abnormal segments (p < 0.03) and higher infarct zone counts during exercise (p < 0.05) and after reinjection (p < 0.05) than Group 2 patients.
If confirmed by larger studies, early rest-redistribution thallium-201 imaging may be a useful technique for identifying residual viability after myocardial infarction.
本研究旨在确定早期静息-再分布铊-201心肌显像在检测心肌梗死后存活心肌方面的效用。
心肌梗死后存活心肌的早期检测具有临床意义。
31例急性心肌梗死患者接受了早期（平均[±标准差]2±1天）静息-再分布铊-201心肌显像，随后进行放射性核素和冠状动脉造影。后期检查包括负荷-再分布-再注射铊-201心肌显像或放射性核素血管造影，或两者皆有。静息铊-201扫描将存活心肌定义为最初的轻度静息缺损或任何显示有再分布的缺损。
第1组（n = 15）梗死区域的心肌预计为存活心肌，第2组（n = 16）为无存活心肌。第1组患者梗死相关动脉通畅的可能性更大（15/15对10/16，p < 0.03），初始射血分数更高（61±12%对53±9%，p < 0.05），梗死壁运动评分更高（p < 0.0001），铊-201异常节段更少（p < 0.0001）。在随访研究中，第1组射血分数有所改善（从57±13%提高到66±10%，p < 0.05，n = 9），第2组射血分数恶化（从53±10%降至46±8%，p < 0.05，n = 13）。在后期铊-201再注射负荷试验中，第1组患者的异常节段比第2组患者少（p < 0.03），运动时（p < 0.05）和再注射后（p < 0.05）梗死区域计数更高。
如果更大规模的研究得到证实，早期静息-再分布铊-201心肌显像可能是识别心肌梗死后存活心肌的一种有用技术。
