经皮腔内冠状动脉成形术后冬眠心肌的延迟代谢恢复：用碘-123-β-甲基-对-碘苯基十五烷酸显像进行评估。

Delayed metabolic recovery of hibernating myocardium after percutaneous transluminal coronary angioplasty: assessment with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid imaging.

作者信息

Takeishi Y, Atsumi H, Fujiwara S, Tomoike H

机构信息

First Department of Internal Medicine, Yamagata University School of Medicine, Japan.

出版信息

J Cardiol. 1996 Jul;28(1):17-25.

PMID:8768502

Abstract

The time course of improvement in fatty acid metabolism after percutaneous transluminal coronary angioplasty (PTCA) was investigated using echocardiography and fatty acid metabolic imaging with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) before, 1 week and 3 months after PTCA in 31 patients with angina pectoris. Decreased left ventricular wall motion before PTCA improved 1 week after PTCA in 13 of 31 patients. 123I-BMIPP uptake was reduced in these 13 patients before PTCA, and did not improve 1 week after PTCA. Decreased myocardial uptake of 123I-BMIPP improved 1 week after PTCA in eight of 23 patients (group A). Thirteen patients in whom 123I-BMIPP uptake had not improved 1 week after PTCA showed a delayed recovery of 3 months after PTCA (group B). All patients in groups A and B showed improvement in wall motion 1 week after PTCA. Patients in group B had a higher incidence of unstable angina (77% vs 25%, p < 0.01), 99% or 100% stenosis (62% vs 13%, p < 0.01) and collateral vessels (46% vs 13%, p < 0.05) than those in group A. Serial fatty acid metabolic imaging with 123I-BMIPP after PTCA showed delayed metabolic recovery after improvement in wall motion in 13 of 23 patients. The presence of severe myocardial ischemia before PTCA enhanced the chronological discrepancies between the recovery of wall motion and fatty acid metabolism.

摘要

在31例心绞痛患者中，于经皮腔内冠状动脉成形术（PTCA）前、术后1周和3个月，采用超声心动图以及用碘-123-甲基-对碘苯基十五烷酸（123I-BMIPP）进行脂肪酸代谢成像，研究PTCA后脂肪酸代谢改善的时间进程。31例患者中，13例患者PTCA前左心室壁运动减弱，术后1周有所改善。这13例患者PTCA前123I-BMIPP摄取减少，术后1周未改善。23例患者中有8例（A组）PTCA后1周心肌对123I-BMIPP的摄取减少情况有所改善。PTCA后1周123I-BMIPP摄取未改善的13例患者（B组），PTCA后3个月显示出延迟恢复。A组和B组所有患者PTCA后1周壁运动均有改善。B组患者不稳定型心绞痛发生率更高（77% 对25%，p<0.01），99%或100%狭窄发生率更高（62%对13%，p<0.01），侧支血管发生率更高（46%对13%，p<0.05）。PTCA后用123I-BMIPP进行系列脂肪酸代谢成像显示，23例患者中有13例壁运动改善后脂肪酸代谢恢复延迟。PTCA前存在严重心肌缺血会加剧壁运动恢复与脂肪酸代谢恢复之间的时间差异。