Flotats Giralt A, Carrió Gasset I, Estorch Cabrera M, Bernà Roqueta L, Catafau Alcántara A M, Marí Aparici C, Ballester Rodés M
Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona.
Rev Esp Cardiol. 1998;51 Suppl 1:45-52.
It has been demonstrated that nitrate administration enhances the detection of myocardial viability in thallium-201 and technetium-99m sestamibi myocardial perfusion studies. The aim of this study was to assess the influence of nitrate administration on technetium-99m tetrofosmin myocardial uptake in patients with coronary artery disease and left ventricular dysfunction.
Twenty eight patients with coronary artery disease, previous myocardial infarction and left ventricular ejection fraction < 40% underwent, within 48 hours, rest/postnitroglycerin (0.4 mg sublingually) technetium-99m tetrofosmin single photon emission tomography (SPET), comparing these results with that of thallium-201 rest/redistribution SPET in 13 patients (first group) and with that of thallium-201 rest/reinjection SPET in the other 15 patients (second group). Tomograms based on the 3 spatial planes were divided into 15 segments and regional tracer uptake was quantitatively analysed. Viability was defined as presence of tracer uptake > or = 50% of peak activity.
The percentage of peak activity at rest or after nitrate administration of technetium-99m tetrofosmin correlated, with that of thallium-201, at rest and after redistribution or reinjection (r = 0.8; p < 0.001). On resting technetium-99m tetrofosmin studies 167 of the 420 segments that were analysed had < 50% of peak activity. 14.5% of these segments showed reversibility after nitrate administration, with an increase in 99mTc-tetrofosmin uptake from 45 +/- 5% to 55 +/- 4% of peak activity (p = 0.001), in the first group, and from 40 +/- 9% to 57 +/- 9% of peak activity (p = 0.003), in the second group. Overall agreement between rest/postnitroglycerin technetium-99m tetrofosmin SPET studies and rest/redistribution or rest/reinjection thallium-201 SPET studies, regarding the presence of myocardial viability, was 87% and 90%, respectively. All except one reversible segments on tetrofosmin studies after nitrates had viability criteria on thallium studies.
Nitrate administration at rest enhances the detection of myocardial viability using technetium-99m tetrofosmin SPET, correlating with viability criteria observed on thallium studies. It represents a simple and useful technique in the assessment of myocardial viability.
已证实，在铊 - 201和锝 - 99m 司他米比心肌灌注研究中，给予硝酸盐可增强心肌存活的检测。本研究的目的是评估给予硝酸盐对冠心病和左心室功能障碍患者锝 - 99m 替曲膦心肌摄取的影响。
28例患有冠心病、既往有心肌梗死且左心室射血分数<40%的患者在48小时内接受了静息/舌下含服硝酸甘油（0.4mg）后锝 - 99m 替曲膦单光子发射断层扫描（SPET），并将这些结果与13例患者的铊 - 201静息/再分布SPET结果（第一组）以及另外15例患者的铊 - 201静息/再注射SPET结果（第二组）进行比较。基于三个空间平面的断层图像被分为15个节段，并对区域示踪剂摄取进行定量分析。存活被定义为示踪剂摄取量>或 = 峰值活性的50%。
锝 - 99m 替曲膦在静息或给予硝酸盐后的峰值活性百分比与铊 - 201在静息、再分布或再注射后的峰值活性百分比相关（r = 0.8；p < 0.001）。在静息锝 - 99m 替曲膦研究中，分析的420个节段中有167个节段的活性<峰值活性的50%。在第一组中，这些节段中有14.5%在给予硝酸盐后显示出可逆性，锝 - 99m 替曲膦摄取量从峰值活性的45±5%增加到55±4%（p = 0.001），在第二组中从40±9%增加到57±9%（p = 0.003）。静息/舌下含服硝酸甘油后锝 - 99m 替曲膦SPET研究与静息/再分布或静息/再注射铊 - 201 SPET研究在心肌存活存在方面的总体一致性分别为87%和90%。除了一个在给予硝酸盐后替曲膦研究中的可逆节段外，所有其他节段在铊研究中都符合存活标准。
静息时给予硝酸盐可增强使用锝 - 99m 替曲膦SPET检测心肌存活，与铊研究中观察到的存活标准相关。它是评估心肌存活的一种简单且有用的技术。
