Tisselli A, Pieri P, Moscatelli G, Agostini M, Nanni O, Spinelli A, Riva P
Nuclear Medicine Department, M. Bufalini Hospital, Cesena, Italy.
J Nucl Cardiol. 1997 May-Jun;4(3):195-201. doi: 10.1016/s1071-3581(97)90079-9.
The presence of defects at stress-redistribution thallium-201 scintigraphy is related to a higher risk of cardiac events. However, the prognostic value of defects that become reversible after reinjection is not known. In this study we evaluated the prognostic contribution of stress-redistribution-reinjection with special regard to 3-hour fixed defects that become reversible after reinjection.
We studied 122 patients with chronic myocardial infarction (>2 months) and suspected or known residual ischemia, with stress-redistribution-reinjection planar scintigraphy. Thallium scans were analyzed by three observers (three segments per view, 5-point score) and classified as normal, fixed, and reversible. The lung/heart ratio was also calculated. At a median follow-up of 47 months, 10 patients had hard events (four deaths and six myocardial infarctions) (group I), 12 patients had unstable angina (group II), 12 patients underwent planned coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (group III), and 86 patients had no events (group IV). The presence of fixed defects that became reversible after reinjection did not identify patients at higher risk. The number of reversible defects at 3 hours was significantly higher only in patients who underwent revascularization. Unstable angina was not predicted by any scintigraphic pattern. The variables that were statistically related to hard events by univariate analysis were increased lung uptake, reversible cavity dilation, and the number of fixed defects that remained fixed after reinjection. By Cox multivariate analysis, the strongest predictor of hard events was the presence of more than three fixed defects that remained fixed after reinjection as a marker of irreversible myocardial damage.
(201)Tl reinjection is a useful approach for not only detecting viable myocardium but also risk stratification in patients with chronic myocardial infarction.
在负荷-再分布铊-201心肌显像中出现缺损与心脏事件风险较高相关。然而，再注射后变为可逆的缺损的预后价值尚不清楚。在本研究中，我们评估了负荷-再分布-再注射的预后作用，特别关注再注射后变为可逆的3小时固定缺损。
我们对122例慢性心肌梗死（>2个月）且怀疑或已知存在残余缺血的患者进行了负荷-再分布-再注射平面心肌显像研究。铊扫描由三位观察者进行分析（每个视野三个节段，5分制评分），并分类为正常、固定和可逆。还计算了肺/心比值。在中位随访47个月时，10例患者发生了严重事件（4例死亡和6例心肌梗死）（I组），12例患者发生不稳定型心绞痛（II组），12例患者接受了计划性冠状动脉搭桥术或经皮冠状动脉腔内血管成形术（III组），86例患者无事件发生（IV组）。再注射后变为可逆的固定缺损的存在并未识别出高危患者。仅在接受血运重建的患者中，3小时时可逆缺损的数量显著更高。任何心肌显像模式均未预测到不稳定型心绞痛。单因素分析中与严重事件有统计学关联的变量包括肺摄取增加、可逆性心腔扩张以及再注射后仍为固定的固定缺损数量。通过Cox多因素分析，严重事件的最强预测因素是再注射后仍为固定的超过三个固定缺损的存在，作为不可逆心肌损伤的标志。
（201）Tl再注射不仅是检测存活心肌的有用方法，也是慢性心肌梗死患者危险分层的有用方法。
