Greco C, Ciavolella M, Tanzilli G, Sinatra R, Macrina F, Schillaci O, Tavolaro R, Scopinaro F, Campa P P, Marino B
Institute of Cardiac Surgery, Department of Experimental Medicine, University La Sapienza, Rome, Italy.
Cardiovasc Surg. 1998 Apr;6(2):149-55. doi: 10.1016/s0967-2109(97)00143-9.
In order to predict tissue viability in infarcted myocardial areas, changes induced by nitroglycerine infusion on Sestamibi myocardial uptake were evaluated in 37 patients with previously confirmed myocardial infarction undergoing coronary artery bypass grafting, and compared with echocardiographic and perfusional changes occurring after the operation. The improvement of Sestamibi uptake after nitroglycerine correctly classified 24/26 (92%) patients showing postoperative improvement of wall motion in the infarcted area, whereas 24/31 (77%) patients with nitroglycerine-induced increase in Sestamibi uptake had improved wall motion after operation. The presence of collateral flow to the infarcted area was associated with a significantly (P < 0.01) higher increase in Sestamibi uptake both during nitroglycerine infusion and postoperatively. An increase in wall motion score after operation was associated with a significantly higher (P < 0.05) increase in Sestamibi uptake score during nitroglycerine infusion. Thus, the results of this study suggest that Sestamibi perfusional myocardial scintigraphy during nitroglycerine infusion is capable of assessing viable but chronically hypoperfused myocardium and predicting postoperative wall motion and perfusional improvement, to yield the best results in patients with evidence of collateral circulation that supplies the infarcted area.
为了预测梗死心肌区域的组织活力，对37例先前确诊为心肌梗死且正在接受冠状动脉搭桥术的患者，评估了硝酸甘油输注引起的心肌摄取锝[99mTc]甲氧基异丁基异腈（Sestamibi）的变化，并与术后发生的超声心动图和灌注变化进行了比较。硝酸甘油后Sestamibi摄取的改善正确地将24/26（92%）例梗死区域壁运动术后改善的患者分类出来，而24/31（77%）例硝酸甘油引起Sestamibi摄取增加的患者术后壁运动得到改善。梗死区域侧支血流的存在与硝酸甘油输注期间和术后Sestamibi摄取的显著更高增加相关（P<0.01）。术后壁运动评分的增加与硝酸甘油输注期间Sestamibi摄取评分的显著更高增加相关（P<0.05）。因此，本研究结果表明，硝酸甘油输注期间的心肌灌注锝[99mTc]甲氧基异丁基异腈闪烁扫描能够评估存活但长期灌注不足的心肌，并预测术后壁运动和灌注改善，在有梗死区域侧支循环证据的患者中可产生最佳结果。
