Ito K, Sugihara H, Terada K, Matsumoto K, Taniguchi Y, Ohtsuki K, Miyazaki H, Nakagawa T, Azuma A, Maeda T
Second Department of Medicine, Kyoto Prefectural University of Medicine.
Kaku Igaku. 1995 Oct;32(10):1099-106.
Myocardial perfusion and fatty acid metabolism may be unpaired in the patients of vasospastic angina (VSA), because abnormal regional wall motion of left ventricle has been shown in some cases of VSA without apparent history of myocardial infarction. To study the clinical utility of 123I-BMIPP scintigraphy in diagnosis of myocardial ischemia in VSA, both 123I-BMIPP (rest) and 201T1 (exercise) SPECT were performed in the 20 patients of VSA diagnosed by coronary angiography. Defect scores were calculated visually from the 17 segments of myocardial images and were compared with patient's anginal history, period from last attack, numbers of attack, left ventricular (LV) ejection fraction and severity of regional LV wall motion abnormality. 123I-BMIPP SPECT images showed decreased tracer uptake in 14 cases of 20 (70%) VSA patients. Exercise 201T1 SPECT images showed decreased tracer uptake in 3 cases of 20 (15%) of patients. Severity of regional LV wall motion abnormality was correlated with defect score of BMIPP. Though total defect score of BMIPP did not correlate with patient's anginal history, number of symptoms and LV ejection fraction, correlated inversely with period from last attack. It was suggested that 123I-BMIPP myocardial SPECT images in VSA patients showed "memories" of myocardial ischemic damages induced by vasospasm. In summary, 123I-BMIPP myocardial SPECT images could be a useful test for diagnosis and evaluation of VSA.
在变异性心绞痛（VSA）患者中，心肌灌注与脂肪酸代谢可能不匹配，因为在一些无明显心肌梗死病史的VSA病例中已显示出左心室局部室壁运动异常。为研究123I - BMIPP心肌断层显像在VSA心肌缺血诊断中的临床应用价值，对20例经冠状动脉造影确诊的VSA患者进行了123I - BMIPP（静息）和201T1（运动）单光子发射计算机断层显像（SPECT）检查。从心肌图像的17个节段目测计算缺损分数，并与患者的心绞痛病史、上次发作以来的时间、发作次数、左心室（LV）射血分数以及左心室局部室壁运动异常的严重程度进行比较。123I - BMIPP SPECT图像显示，20例VSA患者中有14例（70%）示踪剂摄取减少。运动201T1 SPECT图像显示，20例患者中有3例（15%）示踪剂摄取减少。左心室局部室壁运动异常的严重程度与BMIPP缺损分数相关。虽然BMIPP的总缺损分数与患者的心绞痛病史、症状数量和左心室射血分数无关，但与上次发作以来的时间呈负相关。提示VSA患者的123I - BMIPP心肌SPECT图像显示了由血管痉挛引起的心肌缺血损伤的“记忆”。总之，123I - BMIPP心肌SPECT图像可能是诊断和评估VSA的一项有用检查。
