Juillière Y, Marie P Y, Danchin N, Gillet C, Paille F, Karcher G, Bertrand A, Cherrier F
Department of Cardiology, CHU Nancy-Brabois, Vandoeuvre-les-Nancy, France.
Eur Heart J. 1993 Sep;14(9):1163-9. doi: 10.1093/eurheartj/14.9.1163.
Regional variations in left ventricular contractility and myocardial perfusion are frequent in idiopathic dilated cardiomyopathy and might result from an increase in left ventricular wall stress responsible for regional wall motion abnormalities. The aim of the study was to perform radionuclide studies in patients with idiopathic dilated cardiomyopathy to assess regional left ventricular wall motion and myocardial perfusion abnormalities in this myocardial disease. We studied 29 men referred with idiopathic dilated cardiomyopathy and normal coronary angiograms. Rest radionuclide left ventriculography and exercise thallium-201 tomography were performed in all patients. The thallium-201 tomograms were divided into 20 segments for each patient. Mean left ventricular ejection fraction was 27 +/- 11%; 17 patients had diffuse hypokinesia (mean left ventricular ejection fraction: 24 +/- 9%) and 12 patients had predominant regional hypokinesia (mean left ventricular ejection fraction: 32 +/- 12%). Of all 580 tomographic segments, 186 had a reduction of thallium-201 uptake at exercise. Among them, reversibility was found in 53%. On the whole, 68% (158/232) of anterior, inferior and apical segments had a perfusion abnormality, compared with 8% (28/348) of septal and lateral segments (P < 0.0001). Left ventricular wall motion and myocardial perfusion abnormalities are heterogeneous and not evenly distributed in dilated cardiomyopathy. The alterations are predominant on the myocardial regions delineating the antero-posterior axis of the left ventricle. These findings suggest the possible role of increased left ventricular wall stress on this axis.
特发性扩张型心肌病患者常出现左心室收缩力和心肌灌注的区域差异，这可能是由于左心室壁应力增加导致区域壁运动异常所致。本研究的目的是对特发性扩张型心肌病患者进行放射性核素研究，以评估这种心肌疾病中左心室壁区域运动和心肌灌注异常情况。我们研究了29名因特发性扩张型心肌病且冠状动脉造影正常而转诊的男性患者。所有患者均进行了静息放射性核素左心室造影和运动铊-201断层扫描。每位患者的铊-201断层扫描图像被分为20个节段。平均左心室射血分数为27±11%；17例患者有弥漫性运动减弱（平均左心室射血分数：24±9%），12例患者有主要的区域性运动减弱（平均左心室射血分数：32±12%）。在所有580个断层节段中，186个节段在运动时铊-201摄取减少。其中，53%发现有可逆性。总体而言，前壁、下壁和心尖节段的68%（158/232）有灌注异常，而间隔和侧壁节段的8%（28/348）有灌注异常（P<0.0001）。左心室壁运动和心肌灌注异常是异质性的，在扩张型心肌病中分布不均。这些改变在界定左心室前后轴的心肌区域最为明显。这些发现提示左心室壁在该轴上应力增加可能起到的作用。
