Taki J, Nakajima K, Matsunari I, Bunko H, Takada S, Tonami N
Department of Nuclear Medicine, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920, Japan.
Eur J Nucl Med. 1995 Dec;22(12):1385-92. doi: 10.1007/BF01791146.
In coronary artery disease, discrepancy in the uptake of thallium-201 and of methyl-branched fatty acid at rest has been described. The purpose of this study was to evaluate iodine-123 labelled beta-methyl-branched fatty acid (BMIPP) myocardial uptake and wall motion at rest in segments with stress-induced ischaemia identified by stress 201Tl tomography in patients with chronic coronary artery disease. 123I-BMIPP myocardial tomography was performed at rest and was compared with the findings of exercise-reinjection 201Tl tomography in 45 patients with chronic coronary artery disease. Regional wall motion was evaluated by contrast left ventriculography in 36 patients. Among 237 segments with reversible 201Tl defects, equally decreased uptake on both reinjection 201Tl and BMIPP images was observed in 93 (39%), more severely decreased uptake of BMIPP in 118 (50%) and more severely decreased uptake of reinjection 201Tl in 26 (11%). On the other hand, among 90 segments with non-reversible 201Tl defects, each pattern was observed in 71 (79%), 6 (7%) and 13 (14%) segments, respectively. When comparing the ischaemic segments with and without more severely reduced uptake of BMIPP than of reinjection 201Tl, wall motion was impaired to a greater extent in the segments with more severely reduced uptake of BMIPP than of reinjection 201Tl [severe hypo- or dyskinesis was present in 64 (70%) of 91 segments and in 24 (22%) of 110 segments, respectively, P<0.005]. In patients with chronic coronary artery disease, resting fatty acid uptake was frequently more reduced than reinjection 201Tl in the segments with stress-induced ischaemia, while in most of the fixed perfusion defects BMIPP and reinjection 201Tl uptake decreased concordantly. In ischaemic myocardium, wall motion was impaired to a greater extent in those segments which showed more severely reduced uptake of BMIPP than of reinjection 201Tl. In ischaemic but viable myocardium, discordant BMIPP uptake less than reinjection 201Tl uptake may indicate metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities. In conclusion, the combination of resting BMIPP and stress-reinjection 201Tl imaging may provide information on metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities.
在冠状动脉疾病中，已有人描述过静息状态下铊-201与甲基支链脂肪酸摄取情况的差异。本研究的目的是，对慢性冠状动脉疾病患者中，通过负荷201铊断层扫描识别出的负荷诱导性缺血节段在静息状态下的碘-123标记的β-甲基支链脂肪酸（BMIPP）心肌摄取及室壁运动情况进行评估。对45例慢性冠状动脉疾病患者在静息状态下进行了123I-BMIPP心肌断层扫描，并将结果与运动再注射201铊断层扫描的结果进行比较。通过对比剂左心室造影对36例患者的节段性室壁运动进行了评估。在237个存在可逆性201铊缺损的节段中，再注射201铊和BMIPP图像上摄取均同等程度降低的有93个节段（39%），BMIPP摄取降低更严重的有118个节段（50%），再注射201铊摄取降低更严重的有26个节段（11%）。另一方面，在90个存在不可逆性201铊缺损的节段中，上述每种情况分别见于71个节段（79%）、6个节段（7%）和13个节段（14%）。在比较BMIPP摄取较再注射201铊摄取降低更严重和未降低更严重的缺血节段时，BMIPP摄取较再注射201铊摄取降低更严重的节段室壁运动受损程度更大[91个节段中有64个节段（70%）存在严重运动减弱或运动障碍，110个节段中有24个节段（22%）存在严重运动减弱或运动障碍，P<0.005]。在慢性冠状动脉疾病患者中，在负荷诱导性缺血节段静息状态下的脂肪酸摄取通常较再注射201铊降低更明显，而在大多数固定灌注缺损中BMIPP和再注射201铊摄取呈一致性降低。在缺血心肌中，BMIPP摄取较再注射201铊摄取降低更严重的节段室壁运动受损程度更大。在缺血但存活的心肌中，BMIPP摄取低于再注射201铊摄取的不一致情况可能提示静息状态下独立于灌注异常的代谢改变和室壁运动异常。总之，静息BMIPP与负荷再注射201铊成像相结合可能提供独立于灌注异常的静息状态下代谢改变和室壁运动异常的信息。
