Myocardial thallium-201 scintigraphy for assessment of viability in patients with severe left ventricular dysfunction.
Myocardial thallium-201 scintigraphy for assessment of viability in patients with severe left ventricular dysfunction.
复制标题
心肌铊 201 闪烁扫描用于评估严重左心室功能障碍患者的生存能力。
DOI：
10.1016/0002-9149(92)90034-v
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Gimple,LW
中科院分区：
文献类型：
--
作者：
Beller,GA;Ragosta,M;Watson,DD;Gimple,LW
许多患有缺血性心脏病和左心室（LV）功能低下的患者具有持续微循环灌注和心肌代谢活动的失能区，这些失能区在冠状动脉血运重建术后表现出改善的收缩功能。用于确定左室功能严重下降患者心肌存活性的两种主要无创技术是铊-201（201 TI）放射性成像和正电子发射断层扫描（PET）。在心肌顿抑或短期冬眠（以血流减少和缺血性功能障碍为特征）的实验条件下，201 TI的心肌提取没有改变。无运动或运动障碍的左室壁段可以表现出正常或接近正常的201 TI摄取，只要有一些残留的流量是存在的。201 TI动脉造影可以识别可行的运动不能节段时，严重的冠状动脉疾病患者在静息状态。这些患者中的许多人具有表现出延迟再分布的初始静息缺陷，或表现出血运重建后灌注和功能改善的轻度持续性缺陷。冠状动脉搭桥术后左室射血分数的改善程度与严重区域性心肌失能区的201 TI摄取程度直接相关。Rest 201 TI血流显像可帮助选择冠状动脉疾病和左室功能严重下降的患者，这些患者将从血运重建中获益最大。
Many patients with Ischemic heart disease and depressed left ventricular (LV) function have asynergic zones with sustained microcirculatory perfusion and myocardial metabolic activity that exhibit improved systolic function after coronary revascularization. The 2 predominant noninvasive techniques used to determine myocardial viability in patients with severely depressed LV function are thallium-201 (201TI) scintigraphy and posltron emission tomography (PET). Myocardial extraction of201TI is unaltered under experimental conditions of myocardial stunning or short-term hibernation (characterized by decreased flow and ischemic dysfunction). Akinetic or dyskinetic LV wall segments can exhibit normal or near normal201TI uptake as long as some residual flow is present.201TI scintigraphy can identify viable asynergic segments when performed on patients with severe coronary artery disease who are in the resting state. Many of these patients have initial resting defects that demonstrate delayed redistribution, or mild persistent defects that show improved perfusion and function after revascularization. There is a direct correlation between the extent of201TI uptake in zones of severe regional myocardial asynergy and the magnitude of improvement in resting LV ejection fraction after coronary bypass surgery. Rest201TI scintigraphy may help in the selection of patients wtth coronary artery disease and severely depressed LV function who would benefit the most from revascularization.