铊-201与碘-123 - BMIPP灌注-代谢不匹配在梗死前心绞痛中的预后意义

Outcome significance of thallium-201 and iodine-123-BMIPP perfusion-metabolism mismatch in preinfarction angina.

作者信息

Nakata T, Hashimoto A, Kobayashi H, Miyamoto K, Tsuchihashi K, Miura T, Shimamoto K

机构信息

Second Department of Internal Medicine (Cardiology), Sapporo Medical University School of Medicine, Japan.

出版信息

J Nucl Med. 1998 Sep;39(9):1492-9.

PMID:9744330

Abstract

UNLABELLED

The relevance of brief antecedent ischemia to preservation of myocyte viability and cardiac function is still controversial in humans. Dysfunctioning but viable myocardium shows impaired fatty acid metabolism despite restored coronary perfusion. We asked whether preinfarction angina might be related to preservation of cell viability and better functional recovery in comparison with impaired fatty acid metabolism.

METHODS

Tomographic imagings with thallium and beta-methyl-p-iodophenyl penta-decanoic acid (BMIPP) were performed in 32 patients with first acute myocardial infarction who received primary coronary angioplasty: 20 patients with preexisting angina before infarction (Group A) and 12 without (Group B). Thallium and BMIPP abnormalities were quantified as a severity index by a polar map. Regional function was quantified by ventriculography and followed up.

RESULTS

Despite no significant difference in coronary risk factors, cardiac function and angiographic findings, the thallium severity index was significantly lower than that of BMIPP (62+/-45 versus 96+/-59) in Group A but not in Group B (104+/-65 versus 115+/-68); the thallium severity index in Group A was significantly lower than that in Group B, but there was no significant difference in BMIPP abnormality between them. The BMIPP severity index correlated significantly with that of thallium in both groups. However, the regression line in Group A shifted downward and was statistically different compared with that in Group B. Regional function at an acute stage was significantly improved from 107+/-31 to 70+/-31 s.d./chord during follow-up in Group A but not in Group B (109+/-62 versus 106+/-52). The ratio of the thallium severity index to that of BMIPP at an acute stage was significantly related to improved regional wall motion during follow-up in the reperfused patients (y=-53x + 65, r=0.667).

CONCLUSION

Preinfarction angina preserves myocyte viability relative to fatty acid metabolism, resulting in augmented perfusion-metabolism mismatch and functional improvement in patients undergoing successful reperfusion, indicating cardioprotective effects of preinfarction angina.

摘要

未标记

短暂性心肌缺血对人类心肌细胞活力和心脏功能保存的相关性仍存在争议。尽管冠状动脉灌注恢复，但功能失调但仍存活的心肌显示脂肪酸代谢受损。我们探讨了与脂肪酸代谢受损相比，梗死前心绞痛是否可能与细胞活力的保存及更好的功能恢复有关。

方法

对32例接受直接冠状动脉血管成形术的首次急性心肌梗死患者进行铊和β-甲基-对-碘苯基十五烷酸（BMIPP）断层显像：20例梗死前有心绞痛的患者（A组）和12例无梗死前心绞痛的患者（B组）。铊和BMIPP异常通过极坐标图量化为严重程度指数。通过心室造影对局部功能进行量化并随访。

结果

尽管冠状动脉危险因素、心脏功能和血管造影结果无显著差异，但A组铊严重程度指数显著低于BMIPP（62±45对96±59），而B组无此差异（104±65对115±68）；A组铊严重程度指数显著低于B组，但两组间BMIPP异常无显著差异。两组中BMIPP严重程度指数与铊严重程度指数均显著相关。然而，A组的回归线向下偏移，与B组相比有统计学差异。随访期间，A组急性期局部功能从107±31显著改善至70±31标准差/弦，而B组无改善（109±62对106±52）。再灌注患者急性期铊严重程度指数与BMIPP严重程度指数之比与随访期间局部室壁运动改善显著相关（y = -53x + 65，r = 0.667）。