Kalff V, van Every B, Barton H J, Bergin P J, Esmore D S, Berlangieri S U, Kelly M J
Department of Nuclear Medicine, Alfred Hospital, Prahran, Victoria, Australia.
Eur J Nucl Med. 1998 Mar;25(3):253-8. doi: 10.1007/s002590050225.
This study compares the incidence and extent of hibernating myocardium (defined by myocardial perfusion/metabolism mismatch) in 28 cardiac transplant candidates with ischaemic cardiomyopathy and in 16 other patients with coronary artery disease (CAD) undergoing viability assessment. It then reviews the impact of myocardial perfusion metabolism imaging on management decisions in the transplant candidates at 6 months after scintigraphy. Each patient underwent a planar myocardial thallium-201 and fluorine-18 fluorodeoxyglucose scan on a modified gamma camera. Perfusion/metabolism mismatch was sized semi-quantitatively and each patient was assigned a global mismatch score. Transplant candidates had a lower left ventricular ejection fraction (LVEF) (P < 0.0002) and extent of hibernation myocardium (lower global mismatch score: P = 0.005) than other CAD patients but the difference in respect of mismatch frequency (8/28 vs 9/16 patients) did not reach statistical significance. Transplant candidates with LVEF < 20% had a lower global mismatch score (P < 0.02) than those with an LVEF > or = 20%. Interestingly two of three other CAD patients with LVEF < 20% had a moderate mismatch. Follow-up studies revealed the lack of impact of metabolic imaging as none of the three transplant candidates who eventually underwent revascularisation had hibernating myocardium and transplantation was offered to one of only two candidates with more than one minor mismatch. Thus metabolic imaging in potential transplant candidates may be of limited value because of the very low extent of hibernating myocardium, particularly if LVEF is below 20% and where clinical decisions are often based on many other factors.
本研究比较了28例缺血性心肌病心脏移植候选者与16例接受存活心肌评估的其他冠心病（CAD）患者中冬眠心肌的发生率和范围（通过心肌灌注/代谢不匹配定义）。然后回顾了心肌灌注代谢成像对移植候选者在闪烁扫描后6个月管理决策的影响。每位患者在改良γ相机上接受了平面心肌铊-201和氟-18氟脱氧葡萄糖扫描。灌注/代谢不匹配进行了半定量测量，每位患者都被赋予了一个整体不匹配分数。与其他CAD患者相比，移植候选者的左心室射血分数（LVEF）较低（P < 0.0002），冬眠心肌范围较小（整体不匹配分数较低：P = 0.005），但在不匹配频率方面的差异（8/28例患者与9/16例患者）未达到统计学意义。LVEF < 20%的移植候选者的整体不匹配分数低于LVEF≥20%的患者（P < 0.02）。有趣的是，另外3例LVEF < 20%的CAD患者中有2例存在中度不匹配。随访研究显示代谢成像没有影响，因为最终接受血运重建的3例移植候选者中没有冬眠心肌，并且仅向2例有多个轻微不匹配的候选者之一提供了移植。因此，由于冬眠心肌范围非常低，潜在移植候选者的代谢成像可能价值有限，特别是当LVEF低于20%且临床决策通常基于许多其他因素时。
