Tomoda H, Yoshioka K, Shiina Y, Tagawa R, Ide M, Suzuki Y
Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan.
Am Heart J. 1994 Sep;128(3):452-8. doi: 10.1016/0002-8703(94)90616-5.
Previous studies have revealed that the sympathetic nervous system is more vulnerable to ischemia than the myocardium itself. Thus our study was undertaken to detect denervated myocardium in non-Q-wave myocardial infarction (MI) and unstable angina with iodine 123 metaiodobenzylguanidine (123I-MIBG), which can delineate myocardial sympathetic innervation. Eight patients with non-Q-wave MI and 12 with unstable angina were studied. Sequential 123I-MIBG and thallium-201 chloride (201TlCl) imaging and single-photon emission computed tomography (SPECT) were performed at rest 24 +/- 12 days after the last ischemic attack. Myocardial perfusion defect was not detected by 201TlCl in 4 of 8 patients with non-Q-wave MI, whereas 123I-MIBG SPECT imaging revealed defects corresponding to myocardial ischemic areas predicted by coronary angiography in all 8 patients. 123I-MIBG imaging revealed defects in 7 of 12 patients with unstable angina corresponding to coronary angiographic findings, whereas no myocardial perfusion defect was detected by 201TlCl imaging in any of them. In conclusion, 123I-MIBG SPECT is a sensitive method for detecting myocardium exposed to transient ischemia that cannot be detected by 201TlCl imaging.
以往研究显示，交感神经系统比心肌本身更易受到缺血的影响。因此，我们开展了这项研究，采用碘123间碘苄胍（123I-MIBG）来检测非Q波心肌梗死（MI）和不稳定型心绞痛患者的失神经支配心肌，123I-MIBG可描绘心肌交感神经支配情况。对8例非Q波MI患者和12例不稳定型心绞痛患者进行了研究。在末次缺血发作后24±12天静息状态下，进行了连续的123I-MIBG和氯化铊-201（201TlCl）显像及单光子发射计算机断层扫描（SPECT）。8例非Q波MI患者中有4例201TlCl未检测到心肌灌注缺损，而所有8例患者的123I-MIBG SPECT显像均显示与冠状动脉造影预测的心肌缺血区域相对应的缺损。12例不稳定型心绞痛患者中有7例123I-MIBG显像显示的缺损与冠状动脉造影结果相符，而他们中任何一例201TlCl显像均未检测到心肌灌注缺损。总之，123I-MIBG SPECT是一种检测201TlCl显像无法检测到的短暂缺血心肌的敏感方法。
