Li S T, Liu X J, Lu Z L, Shi R F, Zhu X D, Chen W Q, Wu Q W, Liu Y Z
Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China.
J Nucl Cardiol. 1996 Nov-Dec;3(6 Pt 1):457-63. doi: 10.1016/s1071-3581(96)90055-0.
Assessment of viable myocardium in territories of hypoperfused myocardium is important for predicting functional recovery after revascularization. This study was designed to evaluate quantitative analysis of 99mTc-labeled 2-methoxyisobutyl isonitrile (MIBI) myocardial perfusion imaging combined with isosorbide dinitrate (ISDN) infusion to detect myocardial viability in patients with chronic coronary artery disease before and after revascularization.
Twenty-seven consecutive patients with previous myocardial infarction and left ventricular dysfunction (left ventricular ejection fraction 35.2% +/- 13.5%) referred for coronary artery bypass (CABG) were studied with 99mTc-labeled MIBI single-photon emission computed tomography at rest and during ISDN infusion before CABG followed by resting imaging after CABG. Quantitative analysis was performed with circumferential profiles. Left ventricular function (global and regional) was assessed by radionuclide ventriculography before and after CABG. Out of 212 abnormal perfusion segments with resting 99mTc-labeled MIBI SPECT, 99 segments (47%) showed improved uptake of 99mTc-labeled MIBI during ISDN infusion. The mean ratio of myocardial uptake was 0.58 +/- 0.25 (resting 0.53 +/- 0.23; p < 0.05). After CABG, of 212 segments with hypoperfusion, 108 segments (51%; p > 0.05 vs ISDN) showed improved uptake of 99mTc-labeled MIBI. The mean ratio of myocardial uptake was 0.60 +/- 0.26 (resting 0.53 +/- 0.23; p < 0.05). The concordance between the improvement of post-CABG wall motion and that of pre-CABG ISDN perfusion imaging was 83%, between the improvement of wall motion and perfusion imaging after CABG 94%, and between the improvement of pre-CABG ISDN and post-CABG perfusion imaging 83%, respectively.
ISDN infusion can improve the uptake of 99mTc-labeled MIBI in hypoperfused myocardium and increase the efficiency of 99mTc-labeled MIBI in the detection of viable myocardium in patients with previous myocardial infarction and left ventricular dysfunction.
评估灌注不足心肌区域的存活心肌对于预测血运重建后的功能恢复很重要。本研究旨在评估99mTc标记的甲氧基异丁基异腈（MIBI）心肌灌注显像联合硝酸异山梨酯（ISDN）静脉滴注对慢性冠状动脉疾病患者血运重建前后存活心肌的定量分析。
连续纳入27例曾发生心肌梗死且左心室功能不全（左心室射血分数35.2%±13.5%）并拟行冠状动脉旁路移植术（CABG）的患者，在CABG术前静息及ISDN静脉滴注期间行99mTc标记的MIBI单光子发射计算机断层显像，术后行静息显像。采用圆周剖面进行定量分析。CABG术前和术后通过放射性核素心室造影评估左心室功能（整体和局部）。在静息状态下99mTc标记的MIBI单光子发射计算机断层显像显示的212个灌注异常节段中，99个节段（47%）在ISDN静脉滴注期间99mTc标记的MIBI摄取改善。心肌摄取的平均比值为0.58±0.25（静息时0.53±0.23；p<0.05）。CABG术后，在212个灌注不足节段中，108个节段（51%；与ISDN相比，p>0.05）99mTc标记的MIBI摄取改善。心肌摄取的平均比值为0.60±0.26（静息时0.53±0.23；p<0.05）。CABG术后室壁运动改善与术前ISDN灌注显像改善之间的一致性为83%，CABG术后室壁运动与灌注显像改善之间的一致性为94%，术前ISDN与CABG术后灌注显像改善之间的一致性为83%。
ISDN静脉滴注可改善灌注不足心肌中99mTc标记的MIBI摄取，并提高99mTc标记的MIBI在曾发生心肌梗死且左心室功能不全患者中检测存活心肌的效率。
