Kim Y, Goto H, Kobayashi K, Sawada Y, Miyake Y, Fujiwara G, Chiba H, Okada T, Nishimura T
Department of Internal Medicine, Nishiyodo Hospital, Japan.
Ann Nucl Med. 1997 Aug;11(3):207-12. doi: 10.1007/BF03164765.
Fatty acid metabolism has been reported to be impaired earlier than myocardial blood flow in left ventricular hypertrophic myocardium, e.g., in hypertrophic cardiomyopathy or hypertensive heart disease. The purpose of this study was to determine whether impaired fatty acid metabolism also occurs in right ventricular (RV) hypertrophy. The subjects consisted of 6 patients with chronic obstructive pulmonary disease, 4 with primary pulmonary hypertension, 2 each with refractory pulmonary tuberculosis, tricuspid insufficiency, pulmonary embolism, 1 each with atrial septal defect, ventricular septal defect (Eisenmenger complex), Ebstein anomaly, and endocardial defect, and 7 healthy controls. SPECT imaging with Tl-201 (Tl) and I-123 beta-methyliodophenyl pentadecanoic acid (BMIPP), and Tc-99m RBC first pass and gated blood pool scintigraphy were performed. Based on Tl planar images, the subjects were classified into 3 groups: 7 patients with no RV visualization (Group A), 11 with moderate RV visualization (Group B) and 9 with marked RV visualization (Group C). As a semi-quantitative evaluation by Tl myocardial SPECT, 3 regions in 3 representative short axial images were divided into 9 segments, each of which was graded from 0 to +3, and their sum was calculated as the RV score. The right ventricular ejection fraction (RVEF) and the left ventricular ejection fraction were obtained by Tc-99m RBC cardiac scintigraphy. The groups with marked visualization of the right ventricle had lower RVEF (p < 0.01), and there was a good correlation between the RVEF and the RV score with both Tl and BMIPP (Tl: r = -0.79, BMIPP: r = -0.70). Although a good correlation was demonstrated between the RV score with Tl and BMIPP in Groups A and B (r = 0.86, p < 0.001), in Group C, in which there was marked RV T1 visualization, the RV score with BMIPP was significantly smaller than with Tl (BMIPP vs. Tl: 11.5 +/- 3.7 vs. 16.4 +/- 3.8, p < 0.01). These findings suggest that impaired fatty acid metabolism may exist in severely hypertrophic right ventricle due to RV overload.
据报道，在左心室肥厚心肌中，脂肪酸代谢受损比心肌血流受损更早出现，例如在肥厚型心肌病或高血压性心脏病中。本研究的目的是确定右心室（RV）肥厚时是否也存在脂肪酸代谢受损。研究对象包括6例慢性阻塞性肺疾病患者、4例原发性肺动脉高压患者、2例难治性肺结核、三尖瓣关闭不全、肺栓塞患者，各1例房间隔缺损、室间隔缺损（艾森曼格综合征）、埃布斯坦畸形和心内膜缺损患者，以及7名健康对照者。进行了用Tl - 201（Tl）和I - 123β - 甲基碘苯基十五烷酸（BMIPP）的SPECT成像，以及Tc - 99m红细胞首次通过和门控血池闪烁显像。根据Tl平面图像，将研究对象分为3组：7例右心室未显影患者（A组）、11例右心室中度显影患者（B组）和9例右心室明显显影患者（C组）。作为通过Tl心肌SPECT的半定量评估，在3张代表性短轴图像中的3个区域被分为9个节段，每个节段从0到 +3分级，并计算它们的总和作为右心室评分。通过Tc - 99m红细胞心脏闪烁显像获得右心室射血分数（RVEF）和左心室射血分数。右心室明显显影的组RVEF较低（p < 0.01），并且RVEF与Tl和BMIPP的右心室评分之间均存在良好的相关性（Tl：r = -0.79，BMIPP：r = -0.70）。虽然在A组和B组中Tl和BMIPP的右心室评分之间显示出良好的相关性（r = 0.86，p < 0.001），但在C组中，右心室Tl明显显影，BMIPP的右心室评分显著小于Tl（BMIPP与Tl：11.5±3.7对16.4±3.8，p < 0.01）。这些发现表明，由于右心室负荷过重，严重肥厚的右心室可能存在脂肪酸代谢受损。
