心肌功能障碍的血流动力学指标与双嘧达莫铊-201单光子发射计算机断层扫描相关。

Hemodynamic indices of myocardial dysfunction correlate with dipyridamole thallium-201 SPECT.

作者信息

Chin B B, Moshin J, Bouchard M, Berlin J A, Araujo L I, Alavi A

机构信息

Department of Radiology and Nuclear Medicine, Johns Hopkins University Hospital, Baltimore, Maryland 21287, USA.

出版信息

J Nucl Med. 1996 May;37(5):723-9.

PMID:8965134

Abstract

UNLABELLED

Important differences in hemodynamics and tracer kinetics occur with dipyridamole compared to exercise scintigraphy. To better understand the clinical significance of dipyridamole SPECT 201Tl scintigraphy, we examined the relationships between scintigraphy and clinical, and angiographic and hemodynamic variables in patients with CAD.

METHODS

Forty-nine subjects were divided into three study groups. Patients in Groups A (n = 11) and B (n = 20) had a low (<5%) likelihood of CAD. Group A underwent maximal exercise thallium stress testing. Group B underwent thallium dipyridamole scintigraphy. Group C (n = 18) consisted of patients with coronary artery disease who had dipyridamole thallium scintigraphy and cardiac catheterization within 2 wk. Thallium lung-to-myocardial ratio (L/M), left ventricular dilation and perfusion defect site were compared to hemodynamic, clinical and angiographic variables.

RESULTS

The Group A L/M ratio of 0.23 +/- 0.05 (mean +/- 1 s.d.) was significantly lower (p < 0.001) compared to the Group B L/M ratio of 0.31 +/- 0.05. In Group C, the UM ratio showed correlation with indices of left ventricular dysfunction including lower resting ejection fraction (p = 0.02, r = 0.83), higher pulmonary capillary wedge pressure (p = 0.01, r = 0.58) and lower cardiac index (p = 0.03, r = 0.54). Left ventricular dilation was associated with hemodynamic changes of ventricular failure including lower resting ejection fraction (p = 0.008, r = 0.88) and higher pulmonary capillary wedge pressure (p = 0.02, r =0.54). Immediate and delayed perfusion defect size showed good correlation with lower resting left ventricular ejection fraction (p = 0.02, r = 0.83, and p = 0.004, r = 0.91, respectively).

CONCLUSION

Lung uptake, left ventricular dilation and perfusion defect size show good correlation to hemodynamic indices of resting left ventricular dysfunction. A combination of these factors may be a better predictor of future cardiac events and prognosis.

摘要

未标记

与运动闪烁扫描相比，双嘧达莫在血流动力学和示踪剂动力学方面存在重要差异。为了更好地理解双嘧达莫SPECT 201Tl闪烁扫描的临床意义，我们研究了CAD患者闪烁扫描与临床、血管造影和血流动力学变量之间的关系。

方法

49名受试者分为三个研究组。A组（n = 11）和B组（n = 20）患者患CAD的可能性较低（<5%）。A组进行最大运动铊负荷试验。B组进行双嘧达莫铊闪烁扫描。C组（n = 18）由在2周内进行双嘧达莫铊闪烁扫描和心导管检查的冠心病患者组成。比较铊肺/心肌比值（L/M）、左心室扩张和灌注缺损部位与血流动力学、临床和血管造影变量。

结果

A组的L/M比值为0.23±0.05（平均值±1标准差），显著低于B组的L/M比值0.31±0.05（p < 0.001）。在C组中，L/M比值与左心室功能障碍指标相关，包括静息射血分数较低（p = 0.02，r = 0.83）、肺毛细血管楔压较高（p = 0.01，r = 0.58）和心脏指数较低（p = 0.03，r = 0.54）。左心室扩张与心力衰竭的血流动力学变化相关，包括静息射血分数较低（p = 0.008，r = 0.88）和肺毛细血管楔压较高（p = 0.02，r = 0.54）。即时和延迟灌注缺损大小与静息左心室射血分数较低有良好的相关性（分别为p = 0.02，r = 0.83和p = 0.004，r = 0.91）。