Ito T, Tanouchi J, Kato J, Morioka T, Nishino M, Iwai K, Tanahashi H, Yamada Y, Hori M, Kamada T
Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Eur J Nucl Med. 1996 Aug;23(8):917-23. doi: 10.1007/BF01084365.
A discrepancy between myocardial perfusion defect and wall motion abnormalities is frequently found early after coronary reperfusion in patients with acute myocardial infarction. The purpose of this study was to assess recovery of impaired left ventricular function by reference to the discordance in defect size between myocardial fatty acid uptake and myocardial perfusion using combined single-photon emission tomographic (SPET) imaging early after coronary perfusion therapy. In 37 patients with acute myocardial infarction, iodine-123 15-(p-iodophenyl)-3(R, S)-methylpentadecanoic acid (BMIPP) and thallium-201 SPET scans were performed early after coronary reperfusion. A severity score was determined from the extent of the imaging defect with each tracer. Left ventricular wall motion score (WMS) and ejection fraction (EF) were obtained at admission and at 4 weeks after the onset of infarction. In 32 of the 37 patients, discordance in defect sizes delineated with the two SPET studies was found during the acute stage. The severity score for BMIPP was larger than that for 201Tl during the acute stage (7. 7+/-2.4 vs 4.4+/-2.5, P <0.001). There was a fair correlation between the severity score for BMIPP and WMS (r=0.82, P <0.0001), but a poor correlation between that for 201Tl and WMS. The extent of discordance in severity scores between BMIPP and 201Tl during the acute stage correlated well with the extent of the improvement in WMS (r=0.86, P <0.0001) and that of EF (r=0.85, P <0.0001). We conclude that the discordance in defect size on BMIPP and 201Tl SPET images during the acute stage of infarction is an early predictor of the viability of the myocardium at risk of infarction.
急性心肌梗死患者冠状动脉再灌注后早期，常发现心肌灌注缺损与室壁运动异常之间存在差异。本研究的目的是在冠状动脉灌注治疗后早期，通过联合单光子发射断层扫描（SPET）成像，参考心肌脂肪酸摄取与心肌灌注缺损大小的不一致性，评估受损左心室功能的恢复情况。对37例急性心肌梗死患者在冠状动脉再灌注后早期进行了碘-123 15-（对碘苯基）-3（R，S）-甲基十五烷酸（BMIPP）和铊-201 SPET扫描。根据每种示踪剂成像缺损的范围确定严重程度评分。在入院时及梗死发作后4周时获取左心室壁运动评分（WMS）和射血分数（EF）。37例患者中有32例在急性期发现两种SPET研究描绘的缺损大小不一致。急性期BMIPP的严重程度评分大于201Tl的严重程度评分（7.7±2.4对4.4±2.5，P<0.001）。BMIPP的严重程度评分与WMS之间存在良好的相关性（r=0.82，P<0.0001），但201Tl的严重程度评分与WMS之间的相关性较差。急性期BMIPP与201Tl严重程度评分的不一致程度与WMS的改善程度（r=0.86，P<0.0001）和EF的改善程度（r=0.85，P<0.0001）密切相关。我们得出结论，梗死急性期BMIPP和201Tl SPET图像上缺损大小的不一致是梗死危险心肌存活能力的早期预测指标。
