Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography.
Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography.
复制标题
通过正电子发射断层扫描评估急性心肌梗死患者的局部心肌代谢。
DOI：
10.1016/s0735-1097(86)80420-x
复制
发表时间：
1986
影响因子：
24
通讯作者：
Schelbert,HR
中科院分区：
文献类型：
--
作者：
Schwaiger,M;Brunken,R;Grover-McKay,M;Krivokapich,J;Child,J;Tillisch,JH;Phelps,ME;Schelbert,HR
正电子发射断层扫描已被证明可以区分可逆和不可逆的缺血性组织损伤。应用该技术对13例急性心肌梗死患者在发病72小时内分别用氮(NI-13氨)和氟(F)-18脱氧葡萄糖评价局部血流和葡萄糖代谢。对室壁运动进行一系列无创性评估，以确定代谢指标对功能组织恢复的预后价值。应用周向分布技术评估节段血流和葡萄糖利用，并与先前建立的半定量标准进行比较。32个左心室节段的相对N-13氨摄取量降低。16个节段的血流量和葡萄糖代谢均出现一致性下降。在这些细分领域中，区域功能没有随着时间的推移而改变。相比之下，其他16个血流减少的节段显示，F-18脱氧葡萄糖摄取与剩余的存活组织一致。这些节段的平均室壁运动评分显著改善(p<；0.01)，但不同患者的恢复程度差别很大。13例患者中有9例进行了冠状动脉解剖检查：10个节段中有8个心肌梗死未通血管摄取F-18脱氧葡萄糖，而13个闭塞血管节段中有10个节段血流和代谢一致减少(P<；0.01)。因此，正电子发射断层扫描显示心肌梗死亚急性期室壁节段残余组织存活率高，血流减少，功能受损。残留组织代谢缺失与不可逆转的损伤有关，而代谢活性的保存则确定了具有不同结果的节段。正电子发射断层扫描可以早期识别存活但危险的组织，并为抢救危险心肌的积极治疗提供指导。
Positron emission tomography has been shown to distinguish between reversible and irreversible ischemic tissue injury. Using this technique, 13 patients with acute myocardial infarction were studied within 72 hours of onset of symptoms to evaluate regional blood flow and glucose metabolism with nitrogen (NI-13 ammonia and fluorine (F)-18 deoxyglucose, respectively. Serial noninvasive assessment of wall motion was performed to determine the prognostic value of metabolic indexes for functional tissue recovery. Segmental blood flow and glucose utilization were evaluated using a circumferential profile technique and compared with previously established semiquantitative criteria.Relative N-13 ammonia uptake was depressed in 32 left ventricular segments. Sixteen segments demonstrated a concordant decrease in flow and glucose metabolism. Regional function did not change over time in these segments. In contrast, 16 other segments with reduced blood flow revealed maintained F-18 deoxyglucose uptake consistent with remaining viable tissue. The average wall motion score improved significantly in these segments (p < 0.01), yet the degree of recovery varied considerably among patients. Coronary anatomy was defined in 9 of 13 patients: patent infarct vessels supplied 8 of 10 segments with F-18 deoxyglucose uptake, while 10 of 13 segments in the territory of an occluded vessel showed concordant decreases in flow and metabolism (p < 0.01).Thus, positron emission tomography reveals a high incidence of residual tissue viability in ventricular segments with reduced flow and impaired function during the subacute phase of myocardial infarction. Absence of residual tissue metabolism is associated with irreversible injury, while preservation of metabolic activity identifies segments with a variable outcome. Positron emission tomography may allow early identification of viable but jeopardized tissue and provide guidelines for aggressive therapy to salvage endangered myocardium.