Kerber S, Puschkas C, Jonas M, Janssen F, Heinemann-Vechtel O, Kosch M, Deng M C, Schober O, Scheld H H, Breithardt G
Department of Cardiology/Angiology, University of Münster, Germany.
Int J Cardiol. 1996 Nov 15;57(1):91-6. doi: 10.1016/s0167-5273(96)02777-5.
The aim of this study was to compare findings on coronary intravascular ultrasound and thallium-201 SPECT in patients following orthotopic heart transplantation.
No data are available on whether pathological thallium scintigraphic findings in heart recipients are based on coronary vessel wall alterations identifiable by intravascular ultrasound.
29 patients (mean age: 50.9 +/- 11.5 years; male n = 23) were investigated by means of intravascular ultrasound of selected coronary segments and thallium-201 myocardial SPECT. Patients were investigated 11.6 +/- 5.4 weeks post transplantation, a subgroup of 13 patients was re-investigated 70.2 +/- 18.4 weeks following transplantation. A total of 214 cross-sectional areas of the left coronary artery were examined using a 3.5 French intravascular ultrasound catheter to measure intimal index and the circumferential extension of a three-layer appearance of the vessel wall. Shortly after catheterisation, an ergometric stress-test was performed to examine all recipients by means of thallium-201 SPECT. In each patient, 20 segments of the left ventricle were evaluated using a score system of differentiate between persistent defects, redistribution, and reverse redistribution. A score was developed that measured the degree of inhomogeneity and severity of perfusion defects, respectively. Findings on scintigraphy were correlated to coronary intravascular ultrasound findings.
At first investigation, mean intimal index of all evaluated coronary cross-sectional areas was 0.06 +/- 0.1. Sixty-four cross-sectional areas demonstrated a three-layer appearance of the vessel wall, mean circumferential extension was 72 +/- 122 degrees. Thallium scintigraphy demonstrated a total of 336 (40%) pathological left ventricular segments; 168 (20%) were regarded as permanent defects, 67 (8%) demonstrated redistribution and 101 (12%) showed reverse redistribution. The score of inhomogeneity was calculated as 5.8% +/- 2.6%. In the subgroup of patients at the follow-up study, the score was 6.4 +/- 2.8%. There was no correlation between intimal index and the score, nor could any correlation be confirmed between the score and the circumferential extension of a three-layer appearance of the vessel wall. At second investigation, no significant differences of intimal index (0.05 +/- 0.07) or circumferential extension of a three-layer appearance of the vessel wall (74 +/- 118 degrees) could be confirmed. The score was slightly, but significantly increased to 8.1 +/- 4.5% at the second investigation (P < 0.05).
Early after orthotopic heart transplantation, pathologic thallium distribution patterns of the left ventricle could be observed. These pathological patterns did not correlate with the extent of diffuse coronary vessel wall alterations identifiable by intravascular ultrasound. After more than 1 year, the degree of scintigraphic abnormalities increased significantly, not accompanied by an increase of diffuse coronary vessel wall alterations.
本研究旨在比较原位心脏移植术后患者的冠状动脉血管内超声和铊-201单光子发射计算机断层扫描（SPECT）的检查结果。
关于心脏移植受者铊闪烁扫描的病理结果是否基于血管内超声可识别的冠状动脉血管壁改变，目前尚无相关数据。
对29例患者（平均年龄：50.9±11.5岁；男性23例）进行了选定冠状动脉节段的血管内超声检查和铊-201心肌SPECT检查。患者在移植后11.6±5.4周接受检查，13例患者的亚组在移植后70.2±18.4周再次接受检查。使用3.5法国血管内超声导管检查左冠状动脉的214个横截面积，以测量内膜指数和血管壁三层结构的圆周延伸。插管后不久，进行运动负荷试验，通过铊-201 SPECT检查所有受者。在每位患者中，使用评分系统对左心室的20个节段进行评估，以区分持续性缺损、再分布和反向再分布。制定了一个分别测量灌注缺损的不均匀程度和严重程度的评分。闪烁扫描结果与冠状动脉血管内超声结果相关。
首次检查时，所有评估的冠状动脉横截面积的平均内膜指数为0.06±0.1。64个横截面积显示血管壁呈三层结构，平均圆周延伸为72±122度。铊闪烁扫描显示左心室共有336个（40%）病理节段；168个（20%）被视为永久性缺损，67个（8%）显示再分布，101个（12%）显示反向再分布。不均匀性评分为5.8%±2.6%。在随访研究的患者亚组中，评分为6.4±2.8%。内膜指数与评分之间无相关性，评分与血管壁三层结构的圆周延伸之间也未证实有任何相关性。第二次检查时，内膜指数（0.05±0.07）或血管壁三层结构的圆周延伸（74±118度）无显著差异。第二次检查时评分略有但显著增加至8.1±4.5%（P<0.05）。
原位心脏移植术后早期，可观察到左心室铊分布的病理模式。这些病理模式与血管内超声可识别的弥漫性冠状动脉血管壁改变程度无关。1年多后，闪烁扫描异常程度显著增加，而弥漫性冠状动脉血管壁改变未增加。
