Marzullo P, Parodi O, Reisenhofer B, Sambuceti G, Picano E, Distante A, Gimelli A, L'Abbate A
CNR Institute of Clinical Physiology, Pisa, Italy.
Am J Cardiol. 1993 Jan 15;71(2):166-72. doi: 10.1016/0002-9149(93)90733-s.
The relation between radioisotopic and echocardiographic markers of myocardial viability and postrevascularization recovery of function is still to be defined. To this purpose, 14 patients (11 men, 3 women, aged 35 to 64 years, mean 54 +/- 7) with ventricular dysfunction were studied by a multiparametric approach. Each patient underwent, on separate days, rest thallium-201 and technetium-99m sestamibi scintigraphy, dobutamine echocardiography and coronary angiography. Coronary angiography was analyzed by a quantitative approach. Thallium uptake at rest was quantified from planar early (10-minute) and delayed (16-hour) thallium-201 images and expressed as a percentage of maximal activity in each projection using a 13-segment model. Sestamibi uptake was expressed in the same way. Dobutamine (up to 10 micrograms/kg/min) echocardiography was analyzed using a score index ranging from 1 (normokinesia) to 4 (dyskinesia) and a similar segmental model. Before revascularization 50 segments were grouped as normal (coronary stenosis < 50% and normal function, group 1); of the remaining 132 segments with > 50% coronary stenosis, 57 had normal wall motion (group 2) and 75 showed regional dyssynergies (group 3). Early and delayed thallium-201 regional percent activities did not differ in group 1 and in group 2 but were significantly less in group 3 segments. Sestamibi percent activity was more in group 1 and significantly reduced both in group 2 and 3 segments. Segments with improved wall motion after dobutamine had more early, delayed thallium-201 and sestamibi percent activities than unresponsive segments. Postrevascularization echocardiography was performed in all patients. Delayed thallium-201 scans and dobutamine echocardiography showed good sensitivity and specificity in detecting viable myocardium. (ABSTRACT TRUNCATED AT 250 WORDS)
心肌存活的放射性同位素标记物和超声心动图标记物与血运重建后功能恢复之间的关系仍有待明确。为此，采用多参数方法对14例（11例男性，3例女性，年龄35至64岁，平均54±7岁）心室功能障碍患者进行了研究。每位患者在不同日期分别接受静息铊-201和锝-99m甲氧基异丁基异腈闪烁扫描、多巴酚丁胺超声心动图检查和冠状动脉造影。冠状动脉造影采用定量方法进行分析。静息铊摄取量通过平面早期（10分钟）和延迟（16小时）铊-201图像进行定量，并使用13节段模型表示为每个投影中最大活性的百分比。甲氧基异丁基异腈摄取量也以同样方式表示。使用从1（正常运动）到4（运动障碍）的评分指数和类似的节段模型对多巴酚丁胺（高达10微克/千克/分钟）超声心动图进行分析。在血运重建前，50个节段被归类为正常（冠状动脉狭窄<50%且功能正常，第1组）；在其余132个冠状动脉狭窄>50%的节段中，57个节段壁运动正常（第2组），75个节段显示局部运动不协调（第3组）。第1组和第2组的早期和延迟铊-201区域百分比活性无差异，但第3组节段明显较低。甲氧基异丁基异腈百分比活性在第1组中较高，在第2组和第3组节段中均显著降低。多巴酚丁胺后壁运动改善的节段比无反应节段具有更多的早期、延迟铊-201和甲氧基异丁基异腈百分比活性。所有患者均进行了血运重建后超声心动图检查。延迟铊-201扫描和多巴酚丁胺超声心动图在检测存活心肌方面显示出良好的敏感性和特异性。（摘要截断于250字）
