通过多巴酚丁胺超声心动图、正电子发射断层扫描和铊-201单光子发射计算机断层扫描评估心肌活力：与移植心脏组织病理学的相关性

Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT: correlation with histopathology in explanted hearts.

作者信息

Baumgartner H, Porenta G, Lau Y K, Wutte M, Klaar U, Mehrabi M, Siegel R J, Czernin J, Laufer G, Sochor H, Schelbert H, Fishbein M C, Maurer G

机构信息

Department of Cardiology, Vienna General Hospital, University of Vienna, Wien, Austria.

出版信息

J Am Coll Cardiol. 1998 Nov 15;32(6):1701-8. doi: 10.1016/s0735-1097(98)00436-7.

DOI:10.1016/s0735-1097(98)00436-7

PMID:9822099

Abstract

OBJECTIVES

We examined the relationship among viability assessment by dobutamine echocardiography (DE), positron emission tomography (PET) and thallium-201 single-photon emission computed tomography (TI-SPECT) to the degree of fibrosis.

BACKGROUND

DE, PET and TI-SPECT have been shown to be sensitive in identifying viability of asynergic myocardium. However, PET and TI-SPECT indicated viability in a significant percentage of segments without dobutamine response or functional improvement after revascularization.

METHODS

Twelve patients with coronary artery disease and severely reduced left ventricular function (EF 14.5+/-5.2%) were studied with DE prior to cardiac transplantation: 5 had additional PET and 7 had TI-SPECT studies. Results of the three techniques were compared to histologic findings of the explanted hearts.

RESULTS

Segments with >75% viable myocytes by histology were determined to be viable in 78%, 89% and 87% by DE, PET and TI-SPECT; those with 50-75% viable myocytes in 71%, 50% and 87%, respectively. Segments with 25-50% viable myocytes showed response to dobutamine in only 15%, but were viable in 60% by PET and 82% by TI-SPECT. Segments with <25% viable myocytes responded to dobutamine in 19%; however, PET and TI-SPECT demonstrated viability in 33% and 38%, respectively. Discrepant segments without dobutamine response but viability by PET and SPECT had significantly more viable myocytes by pathology than did those classified in agreement to be nonviable but had significantly less viable myocytes than those classified in agreement to be viable (p < .001).

CONCLUSIONS

These findings suggest that contractile reserve as evidenced by a positive dobutamine response requires at least 50% viable myocytes in a given segment whereas scintigraphic methods also identify segments with less viable myocytes. Thus, the methods may provide complementary information: Nuclear techniques appear to be highly sensitive for the detection of myocardial viability, and negative tests make it highly unlikely that a significant number of viable myocytes are present in a given segment. Conversely, dobutamine echo may be particularly useful for predicting recovery of systolic function after revascularization.

摘要

目的

我们研究了多巴酚丁胺超声心动图（DE）、正电子发射断层扫描（PET）和铊 - 201单光子发射计算机断层扫描（TI - SPECT）评估心肌存活性与纤维化程度之间的关系。

背景

DE、PET和TI - SPECT已被证明在识别心肌运动不协调的心肌存活性方面具有敏感性。然而，PET和TI - SPECT显示在相当比例的节段中存在存活性，这些节段在血管重建后对多巴酚丁胺无反应或功能无改善。

方法

对12例冠心病且左心室功能严重降低（射血分数14.5±5.2%）的患者在心脏移植前进行DE检查：其中5例还进行了PET检查，7例进行了TI - SPECT检查。将这三种技术的结果与移植心脏的组织学检查结果进行比较。

结果

组织学显示存活心肌细胞>75%的节段，DE、PET和TI - SPECT判定为存活的比例分别为78%、89%和87%；存活心肌细胞为50 - 75%的节段，相应比例分别为71%、50%和87%。存活心肌细胞为25 - 50%的节段，仅15%对多巴酚丁胺有反应，但PET判定为存活的比例为60%，TI - SPECT为82%。存活心肌细胞<25%的节段，19%对多巴酚丁胺有反应；然而，PET和TI - SPECT判定为存活的比例分别为33%和38%。与PET和SPECT结果不一致的节段，即对多巴酚丁胺无反应但显示存活性的节段，病理学显示其存活心肌细胞明显多于判定为无存活活性但与PET和SPECT结果一致的节段，而明显少于判定为有存活活性且与PET和SPECT结果一致的节段（p < 0.001）。

结论

这些发现表明，多巴酚丁胺阳性反应所证明的收缩储备在给定节段中至少需要50%的存活心肌细胞，而闪烁扫描法也能识别存活心肌细胞较少的节段。因此，这些方法可能提供互补信息：核技术在检测心肌存活性方面似乎高度敏感，阴性检测结果表明给定节段中不太可能存在大量存活心肌细胞。相反，多巴酚丁胺超声心动图对于预测血管重建后收缩功能的恢复可能特别有用。