Soufer R, Dey H M, Lawson A J, Wackers F J, Zaret B L
Department of Radiology, Yale University School of Medicine, New Haven, Connecticut.
J Nucl Med. 1995 Feb;36(2):180-7.
The purpose of this study was to assess myocardial metabolic activity in the area of reverse redistribution and determine the prognostic value of reverse redistribution and PET imaging. Reverse redistribution is thought to be a manifestation of reperfusion therapy and associated with a favorable clinical outcome. Preliminary observations from the Thrombolysis and Myocardial Infarction (TIMI) trial suggest that reverse redistribution is associated with higher incidence of future cardiac events.
Thirty-two patients with chronic coronary artery disease and reverse redistribution on planar thallium scintigraphy had PET 13NH3/18FDG imaging. Radionuclide angiocardiography was performed in 23 patients.
Fifty segments showed reverse redistribution on planar thallium images; 19 segments had normal 13NH3 and 18FDG uptake and 17 were ischemic by PET criteria. Thus, a total of 72% (36 of 50) of reverse redistribution segments were PET viable. Sixty-one percent of segments with abnormal regional wall motion and reverse redistribution were PET scar. On follow-up, 31% (10/32) had a cardiac event (nine unstable angina and one myocardial infarction). Fifty percent of patients (5/10) with cardiac events had severe reverse redistribution and PET viability versus 9% (2/22) without cardiac events (p = 0.01).
The majority of thallium reverse redistribution segments was PET viable as judged by 18FDG uptake. Viability in areas of reverse redistribution is not inferred by regional wall motion analysis. Regional PET viability identifies patients with reverse redistribution with a higher likelihood of future cardiovascular events. PET viability assessment may be helpful with the impact of reverse redistribution on planar thallium scintigraphy.
本研究的目的是评估反向再分布区域的心肌代谢活性，并确定反向再分布和PET成像的预后价值。反向再分布被认为是再灌注治疗的一种表现，与良好的临床结果相关。溶栓与心肌梗死（TIMI）试验的初步观察表明，反向再分布与未来心脏事件的较高发生率相关。
32例慢性冠状动脉疾病患者在平面铊闪烁显像上出现反向再分布，进行了PET 13NH3/18FDG成像。23例患者进行了放射性核素心血管造影。
平面铊图像上有50个节段显示反向再分布；根据PET标准，19个节段13NH3和18FDG摄取正常，17个节段缺血。因此，共有72%（50个中的36个）的反向再分布节段在PET上是存活的。区域壁运动异常且有反向再分布的节段中，61%在PET上为瘢痕。随访中，31%（10/32）发生了心脏事件（9例不稳定型心绞痛和1例心肌梗死）。发生心脏事件的患者中有50%（5/10）有严重的反向再分布和PET存活，而未发生心脏事件的患者中这一比例为9%（2/22）（P = 0.01）。
根据18FDG摄取判断，大多数铊反向再分布节段在PET上是存活的。反向再分布区域的存活情况不能通过区域壁运动分析推断。区域PET存活可识别出有反向再分布且未来发生心血管事件可能性较高的患者。PET存活评估可能有助于了解反向再分布对平面铊闪烁显像的影响。
