Heller L I, Villegas B J, Weiner B H, McSherry B A, Dahlberg S T, Leppo J A
Department of Medicine, University of Massachusetts Medical Center, Worcester 01655.
J Am Coll Cardiol. 1993 May;21(6):1319-27. doi: 10.1016/0735-1097(93)90303-i.
We sought to assess whether sequential teboroxime imaging can rapidly evaluate vessel patency and identify the coronary artery occluded in patients undergoing balloon occlusion of a coronary artery.
Intravenous thrombolytic therapy results in successful reperfusion of the infarct-related artery in only 50% to 80% of cases. A noninvasive technique to serially evaluate coronary perfusion would identify patients who might benefit from other interventions such as emergency percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or increased intensity of thrombolytic therapy.
Teboroxime scans were performed during balloon occlusion in 15 nonconsecutive patients undergoing angioplasty of a major coronary artery. Equivalent views were repeated after successful angioplasty.
The mean time between balloon occlusion and reperfusion imaging was 1.6 +/- 0.6 h. The mean number of defects decreased significantly from 4.13 +/- 1.01 during balloon occlusion to 0.27 +/- 0.44 after reperfusion (p = 0.0006). There was a 30% decrease in the defect/normal zone count/pixel ratios during balloon occlusion and normalization of these ratios after reperfusion (p = 0.0006). The scans correctly identified all nine left anterior descending coronary artery occlusions and both right coronary artery occlusions. One of the four left circumflex coronary artery occlusions was incorrectly identified as a right coronary artery occlusion by scan criteria. Overall, the scans correctly identified the occluded artery 93% of the time (kappa = 0.88). The scan was 100% accurate for distinguishing occlusion of the left anterior descending coronary artery (n = 9) from occlusions of the left circumflex or right coronary artery (n = 6).
We believe that this is the first clinical study to demonstrate that sequential planar imaging with teboroxime can 1) rapidly detect acute coronary artery occlusion and reperfusion, and 2) identify the occluded coronary artery. A trial comparing rapid sequential teboroxime imaging with coronary angiography in patients receiving thrombolytic therapy for acute myocardial infarction is warranted.
我们旨在评估序贯替硼肟成像能否快速评估血管通畅情况，并识别接受冠状动脉球囊闭塞术患者的冠状动脉闭塞情况。
静脉溶栓治疗仅在50%至80%的病例中使梗死相关动脉成功再灌注。一种用于连续评估冠状动脉灌注的非侵入性技术将识别出可能从其他干预措施（如急诊经皮冠状动脉腔内血管成形术、冠状动脉旁路移植术或增加溶栓治疗强度）中获益的患者。
对15例接受主要冠状动脉血管成形术的非连续患者在球囊闭塞期间进行替硼肟扫描。血管成形术成功后重复相同视角的扫描。
球囊闭塞与再灌注成像之间的平均时间为1.6±0.6小时。平均缺损数从球囊闭塞期间的4.13±1.01显著减少至再灌注后的0.27±0.44（p = 0.0006）。球囊闭塞期间缺损/正常区域计数/像素比降低了30%，再灌注后这些比值恢复正常（p = 0.0006）。扫描正确识别了所有9例左前降支冠状动脉闭塞和2例右冠状动脉闭塞。4例左旋支冠状动脉闭塞中有1例根据扫描标准被错误识别为右冠状动脉闭塞。总体而言，扫描在93%的时间内正确识别了闭塞动脉（kappa = 0.88）。该扫描在区分左前降支冠状动脉闭塞（n = 9）与左旋支或右冠状动脉闭塞（n = 6）方面的准确率为100%。
我们认为这是第一项临床研究，证明序贯平面替硼肟成像能够1）快速检测急性冠状动脉闭塞和再灌注，以及2）识别闭塞的冠状动脉。有必要进行一项试验，比较在接受急性心肌梗死溶栓治疗的患者中快速序贯替硼肟成像与冠状动脉造影的效果。
