运动诱发的ST段改变可预测血运重建后左心室缺血性功能障碍的改善：通过正电子发射断层扫描测量局部心肌血流量和心输出量进行评估。

Exercise-induced ST-segment changes permit prediction of improvement in left ventricular ischemic dysfunction after revascularization: evaluation with positron emission tomographic measurements of regional myocardial blood flow and cardiac output.

作者信息

Watanabe T, Harumi K, Michihata T, Okazaki O, Yamanaka H, Akutsu Y, Katagiri T

机构信息

Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.

出版信息

J Nucl Cardiol. 1998 May-Jun;5(3):256-64. doi: 10.1016/s1071-3581(98)90127-1.

DOI:10.1016/s1071-3581(98)90127-1

PMID:9669580

Abstract

BACKGROUND

Prediction of the recovery of left ventricular (LV) ischemic dysfunction after revascularization is important in patients with coronary artery disease (CAD). We investigated whether the improvement in LV ischemic dysfunction after revascularization could be predicted preoperatively by exercise-induced ST-segment changes.

METHODS AND RESULTS

Regional myocardial blood flow (RMBF) and cardiac output were measured with nitrogen 13-ammonia positron emission tomography at rest and during low-level exercise in 28 patients with angiographically proven CAD before and after successful revascularization and in 9 normal subjects. Before revascularization, exercise-induced upsloping ST-segment depression <1 mm 80 msec after the J-point was observed in 11 patients (group 1), horizontal depression of 1 to 1.5 mm was observed in 9 patients (group 2), and downsloping depression > or =1.5 mm was observed in 8 patients (group 3). The number of regions of critical CAD was greater in group 3 than in groups 1 and 2 (3.6 +/- 1.4 vs 1.6 +/- 0.7 and 2.2 +/- 1.1, p < 0.001, p < 0.02). Increase of RMBF in regions of critical CAD with exercise was lower in group 3 than in groups 1 and 2 (0.15 +/- 0.01 vs 0.22 +/- 0.01 and 0.18 +/- 0.02 ml/min per gram, p < 0.0001, p < 0.01). After revascularization, RMBF in regions of critical CAD both at rest and during exercise improved in groups 1 (0.49 +/- 0.15 to 0.60 +/- 0.18, 0.70 +/- 0.26 to 0.86 +/- 0.33 ml/min per gram, both p < 0.05) and 2 (0.50 +/- 0.15 to 0.62 +/- 0.19, 0.67 +/- 0.26 to 0.89 +/- 0.31 ml/min per gram, both p < 0.02), but was unchanged in group 3 (0.47 +/- 0.09 to 0.47 +/- 0.15, 0.62 +/- 0.17 to 0.64 +/- 0.23 ml/min per gram, both p = NS). Cardiac output at rest improved in groups 1 (4.98 +/- 0.43 to 5.35 +/- 0.50 L/min, p < 0.02) and 2 (5.08 +/- 0.52 to 5.53 +/- 0.28 L/min, p < 0.02), but was unchanged in group 3 (4.76 +/- 0.48 to 4.88 +/- 0.82 L/min, p = NS).

CONCLUSIONS

Our results suggest that marked downsloping ST-segment depression induced by preoperative low-level exercise may predict a lack of improvement in LV ischemic dysfunction after revascularization.

摘要

背景

在冠心病（CAD）患者中，预测血运重建后左心室（LV）缺血性功能障碍的恢复情况很重要。我们研究了术前运动诱发的ST段改变是否能预测血运重建后LV缺血性功能障碍的改善情况。

方法与结果

在28例经血管造影证实患有CAD的患者成功进行血运重建前后以及9名正常受试者中，于静息状态和低水平运动期间，使用氮13 - 氨正电子发射断层扫描测量局部心肌血流量（RMBF）和心输出量。在血运重建前，11例患者（第1组）在J点后80毫秒观察到运动诱发的上斜型ST段压低<1毫米，9例患者（第2组）观察到水平压低1至1.5毫米，8例患者（第3组）观察到下斜型压低≥1.5毫米。第3组严重CAD区域的数量多于第1组和第2组（3.6±1.4对1.6±0.7和2.2±1.1，p<0.001，p<0.02）。第3组中严重CAD区域运动时RMBF的增加低于第1组和第2组（0.15±0.01对0.22±0.01和0.18±0.02毫升/分钟/克，p<0.0001，p<0.01）。血运重建后，第1组（0.49±0.15至0.60±0.18，0.70±0.26至0.86±从0.33毫升/分钟/克，p均<0.05）和第2组（0.50±0.15至0.62±0.19，0.67±0.26至0.89±0.31毫升/分钟/克，p均<0.02）严重CAD区域的静息和运动时的RMBF均有所改善，但第3组无变化（0.47±0.09至0.47±0.15，0.62±0.17至0.64±0.23毫升/分钟/克，p均=无显著性差异）。第1组（4.98±0.43至5.35±0.50升/分钟，p<0.02）和第2组（5.08±0.52至5.53±0.28升/分钟，p<0.02）的静息心输出量有所改善，但第3组无变化（4.76±0.48至4.88±0.82升/分钟，p=无显著性差异）。