Schneider C A, Voth E, Gawlich S, Baer F M, Horst M, Schicha H, Erdmann E, Sechtem U
Klinik III für Innere Medizin, Köln, Germany.
J Am Coll Cardiol. 1998 Sep;32(3):648-54. doi: 10.1016/s0735-1097(98)00291-5.
The value of rest technetium-99m (Tc-99m) sestamibi scintigraphy under oral nitrate medication to predict myocardial viability was examined in patients with chronic infarcts.
The value of rest Tc-99m sestamibi to predict viability in infarct regions has not been fully established because significant underestimation of viability, especially in the inferior myocardial wall, has been reported.
Forty patients with Q wave myocardial infarction underwent Tc-99m sestamibi single-photon emission computed tomography under nitrate medication before revascularization of the infarct-related artery. Wall motion was quantified from paired angiograms before and 4 months after revascularization. Tracer uptake was quantified in the central infarct region identified on the angiogram.
The average Tc-99m sestamibi uptake in the central infarct region of patients with anterior infarcts and improvement of left ventricular function was significantly higher (68+/-12%, mean+/-SD) than in patients without improvement of function (40+/-14%, p < 0.02). The average Tc-99m sestamibi uptake in the central infarct region of patients with improvement of function and inferior infarcts was significantly lower (43+/-7%) than in patients with anterior infarcts (68+/-12%, p < 0.003), but was significantly higher than in patients with inferior infarction and no improvement of function (31+/-7%, p < 0.02). Using an infarct location adjusted optimal threshold (50% for anterior infarcts, 35% for inferior infarcts), Tc-99m sestamibi had a positive predictive value of 90% and a negative predictive value of 91% for improvement of left ventricular function.
Quantitative rest Tc-99m sestamibi scintigraphy after oral nitrates reliably predicts improvement of left ventricular function after revascularization if infarct location adjusted thresholds are used.
在慢性梗死患者中，研究口服硝酸盐药物情况下静息态锝-99m（Tc-99m）甲氧基异丁基异腈心肌显像预测心肌存活性的价值。
静息态Tc-99m甲氧基异丁基异腈预测梗死区域心肌存活性的价值尚未完全明确，因为有报道称其对心肌存活性存在显著低估，尤其是在下壁心肌。
40例Q波心肌梗死患者在梗死相关动脉血运重建前接受口服硝酸盐药物情况下的Tc-99m甲氧基异丁基异腈单光子发射计算机断层扫描。通过血运重建前后的配对血管造影对室壁运动进行定量分析。在血管造影上确定的中央梗死区域对示踪剂摄取进行定量分析。
前壁梗死且左心室功能改善患者的中央梗死区域平均Tc-99m甲氧基异丁基异腈摄取（68±12%，平均值±标准差）显著高于功能未改善患者（40±14%，p<0.02）。功能改善且下壁梗死患者的中央梗死区域平均Tc-99m甲氧基异丁基异腈摄取（43±7%）显著低于前壁梗死患者（68±12%，p<0.003），但显著高于下壁梗死且功能未改善患者（31±7%，p<0.02）。使用根据梗死部位调整的最佳阈值（前壁梗死为50%，下壁梗死为35%），Tc-99m甲氧基异丁基异腈对左心室功能改善的阳性预测值为90%，阴性预测值为91%。
如果使用根据梗死部位调整的阈值，口服硝酸盐后进行定量静息态Tc-99m甲氧基异丁基异腈心肌显像可可靠地预测血运重建后左心室功能的改善情况。
