肥厚型心肌病患者双嘧达莫负荷铊-201心肌灌注异常。与临床表现及预后的关系。

Dipyridamole stress thallium-201 perfusion abnormalities in patients with hypertrophic cardiomyopathy. Relationship to clinical presentation and outcome.

作者信息

Yamada M, Elliott P M, Kaski J C, Prasad K, Gane J N, Lowe C M, Doi Y, McKenna W J

机构信息

Kochi Medical School, Japan.

出版信息

Eur Heart J. 1998 Mar;19(3):500-7. doi: 10.1053/euhj.1997.0769.

DOI:10.1053/euhj.1997.0769

PMID:9568455

Abstract

AIMS

Thallium-201 perfusion abnormalities are common in patients with hypertrophic cardiomyopathy and may be associated with an adverse prognosis in the young. The aim of this study was to prospectively determine the relationship between thallium-201 defects during dipyridamole stress to clinical presentation and outcome in a large consecutive series of patients with hypertrophic cardiomyopathy.

METHODS/RESULTS: Thallium-201 single photon computed tomography was performed in 216 patients with hypertrophic cardiomyopathy during dipyridamole stress (0.5 mg. kg-1). Fixed perfusion defects occurred in 25%, and reversible defects in 22%. A combination of defects was present in 7%. Fixed defects were associated with: a history of syncope (17 of 46 with, vs 36 of 170 without syncope, P = 0.03); larger left ventricular end-diastolic (46.9 +/- 7.4 mm vs 43.3 +/- 6.4 mm; P = 0.001) and end-systolic dimension (30.2 +/- 8.4 mm vs 24.5 +/- 5.9 mm, P < 0.0001); increased left atrial diameter (46.1 +/- 8.1 mm vs 40.5 +/- 7.7 mm, P < 0.0001); lower fractional shortening (35.9 +/- 10.4% vs 43.8 +/- 8.6%, P < 0.0001): and lower maximal exercise oxygen consumption (24.2 +/- 8.1 ml. min-1. kg-1 vs 29.4 +/- 8.8 ml. min-1. kg-1, P < 0.0003). Reversible defects did not correlate with symptomatic status, but were associated with: larger left atrial dimensions (44.5 +/- 8.1 mm vs 41.0 +/- 8.0 mm; P = 0.009) and greater maximal left ventricular wall thickness (24.0 +/- 7.0 mm vs 20.6 +/- 7.0 mm, P = 0.003). The mean follow up time was 41 +/- 21 months, range 0.6-124. There was no association between any thallium-201 abnormality and disease related death in young or adult patients.

CONCLUSION

The present study shows that fixed thallium-201 perfusion defects detected during dipyridamole stress in patients with hypertrophic cardiomyopathy are associated with syncope, larger left ventricular cavity dimensions and reduced exercise capacity. Although the event rate was relatively small, there was no evidence for an association between thallium-201 defects and survival.

摘要

目的

201铊灌注异常在肥厚型心肌病患者中很常见，且可能与年轻人的不良预后相关。本研究的目的是前瞻性地确定在一大组连续的肥厚型心肌病患者中，双嘧达莫负荷试验期间201铊缺损与临床表现及预后之间的关系。

方法/结果：对216例肥厚型心肌病患者在双嘧达莫负荷试验（0.5mg·kg-1）期间进行了201铊单光子计算机断层扫描。固定灌注缺损发生率为25%，可逆性缺损为22%。7%的患者存在混合性缺损。固定缺损与以下因素相关：晕厥病史（46例中有17例有晕厥史，170例无晕厥史的患者中有36例，P = 0.03）；更大的左心室舒张末期内径（46.9±7.4mm对43.3±6.4mm；P = 0.001）和收缩末期内径（30.2±8.4mm对24.5±5.9mm，P < 0.0001）；左心房直径增加（46.1±8.1mm对40.5±7.7mm，P < 0.0001）；更低的射血分数（35.9±10.4%对43.8±8.6%，P < 0.0001）；以及更低的最大运动耗氧量（24.2±8.1ml·min-1·kg-1对29.4±8.8ml·min-1·kg-1，P < 0.0003）。可逆性缺损与症状状态无关，但与以下因素相关：更大的左心房内径（44.5±8.1mm对41.0±8.0mm；P = 0.009）和更大的最大左心室壁厚度（24.0±7.0mm对20.6±7.0mm，P = 0.003）。平均随访时间为41±21个月，范围为0.6 - 124个月。在年轻或成年患者中，任何201铊异常与疾病相关死亡之间均无关联。