Implications of "reciprocal" ST segment depression associated with acute myocardial infarction identified by positron tomography.
Implications of "reciprocal" ST segment depression associated with acute myocardial infarction identified by positron tomography.
复制标题
通过正电子断层扫描确定与急性心肌梗死相关的“相互”ST 段压低的含义。
DOI：
10.1016/s0735-1097(83)80300-3
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发表时间：
1983
影响因子：
24
通讯作者：
Geltman,EM
中科院分区：
文献类型：
--
作者：
Billadello,JJ;Smith,JL;Ludbrook,PA;Tiefenbrunn,AJ;Jaffe,AS;Sobel,BE;Geltman,EM
本研究旨在确定明显反向ST段压低的心肌梗死患者是否在远离原发梗死区的区域表现出代谢异常。对20例急性心肌梗塞患者静脉注射~（11）C棕榈酸酯后进行正电子发射断层扫描。前壁7例，下壁13例。前壁梗死患者的下壁导联未出现ST段压低，所有患者的下壁和后壁均出现正常的棕榈酸盐均匀积聚。9例下壁梗死患者（69%）在心前区导联出现ST段压低（明显是可逆的或由于前壁缺血）。与无前壁ST段压低的患者相比，下壁梗死和“反向”ST段压低患者的原发坏死区心肌损伤往往更大。这反映在下壁ST段抬高幅度较大（0.48 ± 0.35 vs 0.07 ± 0.19 mV [±标准差]，p < 0.05），峰值血浆MB肌酸激酶活性（354 ± 134 vs 80 ± 34 IU/L，p < 0.05）和断层摄影估计的梗死面积（58 ± 13 vs 33 ± 10 PET-g-eq）。9例下壁梗死伴胸前导联ST段压低的患者中，3例有ST段压低的前壁断层扫描缺损。因此，尽管大多数下壁梗死和心前导联ST段压低的患者没有前壁代谢损害（67%），表明前壁ST段变化是真正的相互现象，但在一些心前导联心电图异常反映了前壁代谢受损，表明缺血。
This study was performed to determine whether patients with myocardial infarction with apparently reciprocal ST segment depression exhibit abnormal metabolism in zones distant from the primary zone of infarction. Positron emission tomography was performed after the intravenous injection of carbon-11 palmitate in 20 patients with acute myocardial infarction. Infarction was anterior in 7 patients and inferior in 13. Patients with anterior infarction did not show ST segment depression in the inferior leads and all of the patients exhibited normal homogeneous accumulation of palmitate in the inferior and posterior walls. Nine patients with inferior infarction (69%) exhibited ST segment depression (apparently reciprocal or due to anterior wall ischemia) in the anterior precordial leads. Myocardial injury tended to be greater in the primary zone of necrosis among patients with inferior infarction and "reciprocal" ST segment depression compared with those without anterior ST segment depression. This was reflected by the greater total inferior ST segment elevation (0.48 ± 0.35 versus 0.07 ± 0.19 mV [± standard deviation], p < 0.05), peak plasma MB creatine kinase activity (354 ± 134 versus 80 ± 34 IU/liter, p < 0.05) and tomographically estimated infarct size (58 ± 13 versus 33 ± 10 PET-g-eq).Three of the nine patients with inferior infarction and precordial ST depression exhibited anterior tomographic defects underlying the ST segment depression. Thus, although most of the patients with inferior infarction and precordial lead ST segment depression had no anterior wall metabolic compromise (67%) indicating that the anterior ST segment changes were truly reciprocal phenomena, in some the precordial electrocardiographic abnormalities reflected impaired metabolism in the anterior wall indicative of ischemia.