Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: Myocardial stunning or subendocardial hypoperfusion?
Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: Myocardial stunning or subendocardial hypoperfusion?
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DOI：
10.1007/s12350-012-9571-4
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发表时间：
2012-08-01
影响因子：
2.4
通讯作者：
Kritharides, Leonard
中科院分区：
文献类型：
--
作者：
Emmett, Louise;Ng, Austin;Kritharides, Leonard
心肌灌注成像（MPI）上的短暂性缺血性扩张（TID）是一个重要的发现，传达了后续心脏事件的高风险。然而，导致MPI上TID的机制还没有很好地阐明。本研究旨在确定TID是否是由于真正的左心室腔扩张和心室顿抑，或由于相对动脉内膜下低灌注。招募了31例接受单天Tc-99 m腺苷sestamibi MPI的患者。所有患者均进行常规ECG门控单日静息-应激腺苷MPI，同时在静息时、应激后即刻和2小时采集经胸超声心动图（echo）。使用Vivid-7（GE）进行超声心动图检查。在对MPI结果不知情的情况下，使用超声双平面Simpson方法定量测定左室容积和LVEF，将患者分为TID的四分位数，最高四分位数被认为是TID阳性[TID+ 9/31（TID比1.3 +/- A 0.09）]和TID阴性[TID- 22/31（TID比1.01 +/- A 0.04）]。静息超声心动图和MPI物理测量值之间具有良好的相关性（LVEDV r（2）= 0.79，LVESV r（2）= 0.9，LVEF r（2）= 0.75）。在MPI上，观察到TID+组在静息和早期应激之间LVEF显著下降（56.6% vs 46.5%，P <0.002），以及LVESV（62 vs 79 mls，P <0.0001）和LVEDV（113 vs 131 mls，P <0.0001）增加。然而，在同步超声成像上，没有发现LVEF、LVESV或LVEDV的统计学显著变化（LVEF 57% vs 56%，P <0.66; LVESV 48 vs 54 mls，P <0.26; LVEDV 87 vs 97 mls，P <0.299）。超声心动图或MPI显示TID组的LVEF或心室容积无显著变化。腺苷MPI显示的左心室一过性扩张与腔室扩大和心肌顿抑无关，但更可能是内膜下灌注不足和冠状动脉血流储备受损的函数。
Transient ischaemic dilation (TID) on myocardial perfusion imaging (MPI) is an important finding, conveying a high risk of subsequent cardiac events. However, the mechanism leading to TID on MPI is not well elucidated. This study aimed to determine if TID is due to true LV cavity dilation and ventricular stunning, or is due to relative subendocardial hypoperfusion.31 patients undergoing single-day Tc-99m adenosine sestamibi MPI were recruited. All had routine ECG-gated single-day rest-stress adenosine MPI, with transthoracic echocardiograms (echo) acquired concurrently at rest, and both immediately, and 2 hours, post-stress. Echocardiography was performed using a Vivid-7 (GE). LV volumes and LVEF were quantified blinded to MPI results, using biplane Simpson method on echo, and quantitatively (including TID) with QGS(A (R)), on MPI.Patients were divided into quartiles for TID, with the top quartile considered TID positive [TID+ 9/31 (TID ratio 1.3 +/- A 0.09)], and TID negative [TID- 22/31 (TID ratio 1.01 +/- A 0.04)]. There was good correlation between resting echo and MPI physical measurements (LVEDV r (2) = 0.79, LVESV r (2) = 0.9, and LVEF r (2) = 0.75). On MPI, a significant drop in LVEF was observed between rest and early stress in the TID+ group (56.6% vs 46.5%, P < .002), as well as an increase in both LVESV (62 vs 79 mls, P < .0001) and LVEDV (113 vs 131 mls, P < .0001). However, no statistically significant change in LVEF, LVESV or LVEDV was identified on concurrent echo imaging (LVEF 57% vs 56%, P < .66; LVESV 48 vs 54 mls, P < .26; LVEDV 87 vs 97 mls, P < .299). No significant change in LVEF or ventricular volumes was noted in the TID- group by either echo or MPI.Transient dilation of the left ventricle on adenosine MPI is not related to chamber enlargement and myocardial stunning, but is more likely a function of subendocardial hypoperfusion and impaired coronary flow reserve.