[冠状动脉疾病老年患者无症状心肌缺血的机制——双嘧达莫铊闪烁显像评估]

[Mechanism of silent myocardial ischemia in elderly patients with coronary artery disease--assessment by dipyridamole thallium scintigraphy].

作者信息

Murai T, Yamasaki F, Yabe T, Kitaoka H, Matsumura Y, Furuno T, Chikamori T, Doi Y

机构信息

Department of Medicine & Geriatrics, Kochi Medical School.

出版信息

Nihon Ronen Igakkai Zasshi. 1997 May;34(5):402-8. doi: 10.3143/geriatrics.34.402.

DOI:10.3143/geriatrics.34.402

PMID:9267152

Abstract

To evaluate the clinical significance of silent myocardial ischemia in elderly patients with coronary artery disease, 147 patients (aged 65 years and older) underwent coronary angiography and dipyridamole thallium scintigraphy. Seventy-four patients (44 men, 30 women) who showed reversible defects (RD) and ischemic ST depression during scintigraphy were divided into two groups: 13 with silent RD (18%, 12 men, 1 woman), and 61 with painful RD (82%, 32 men, 29 women). Most patients with silent RD were men. The prevalence of myocardial infarction was similar in patients with silent RD (62%) and in patients with painful RD (49%). The prevalence of multivessel disease was also similar in the two groups: 85% in patients with silent RD and 82% in patients with painful RD. Among 38 patients with infarction, 8 had silent RD and 30 had painful RD. The prevalence of RD in the area of infarction was greater in patients with silent RD (63%) than in patients with painful RD (47%), but the difference was not statistically significant. The prevalence of extensive infarction (fixed defects) was greater in patients with silent RD (75%) than in patients with painful RD (30%, p < 0.05). Among 36 patients without infarction, there was no scintigraphic parameter which showed significant difference. Bypass grafting and angioplasty were initially performed in 23% of the patients with silent RD and in 36% of the patients with painful RD (ns). When the two groups were treated medically during the follow-up period of 29 +/- 22 months, the incidences of cardiac events were similar: 10% in patients with silent RD and 13% in patients with painful RD. The prevalence of silent RD is not high in elderly patients with significant coronary artery disease. Compared with the patients with painful RD, those with silent RD were more likely to have an old and extensive myocardial infarction, and they tended to have RD in the area of the infarct.

摘要

为评估无症状心肌缺血在老年冠心病患者中的临床意义，147例年龄在65岁及以上的患者接受了冠状动脉造影和双嘧达莫铊闪烁扫描。74例在闪烁扫描期间显示可逆性缺损（RD）和缺血性ST段压低的患者（44例男性，30例女性）被分为两组：13例无症状RD（18%，12例男性，1例女性），61例有症状RD（82%，32例男性，29例女性）。大多数无症状RD患者为男性。无症状RD患者心肌梗死的患病率（62%）与有症状RD患者（49%）相似。两组多支血管病变的患病率也相似：无症状RD患者为85%，有症状RD患者为82%。在38例梗死患者中，8例有无症状RD，30例有有症状RD。无症状RD患者梗死区域RD的患病率（63%）高于有症状RD患者（47%），但差异无统计学意义。无症状RD患者广泛梗死（固定缺损）的患病率（75%）高于有症状RD患者（30%，p<0.05）。在36例无梗死的患者中，没有闪烁扫描参数显示出显著差异。无症状RD患者中23%和有症状RD患者中36%最初接受了搭桥手术和血管成形术（无显著差异）。在29±22个月的随访期内对两组进行药物治疗时，心脏事件的发生率相似：无症状RD患者为10%，有症状RD患者为13%。在有严重冠状动脉疾病的老年患者中，无症状RD的患病率不高。与有症状RD患者相比，无症状RD患者更可能有陈旧性广泛心肌梗死，且梗死区域更易出现RD。