DIFFUSE SLOW WASHOUT OF MYOCARDIAL TL-201 - A NEW SCINTIGRAPHIC INDICATOR OF EXTENSIVE CORONARY-ARTERY DISEASE
DIFFUSE SLOW WASHOUT OF MYOCARDIAL TL-201 - A NEW SCINTIGRAPHIC INDICATOR OF EXTENSIVE CORONARY-ARTERY DISEASE
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DOI：
10.1016/s0735-1097(84)80319-8
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发表时间：
1984-01-01
影响因子：
24
通讯作者：
BERMAN, DS
中科院分区：
文献类型：
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作者：
BATEMAN, TM;MADDAHI, J;BERMAN, DS
当冠状动脉疾病广泛且严重程度相对均匀时，局部心肌灌注不足可能在应激期间得到平衡，从而防止空间相对灌注缺陷的发展。对心肌区域的 201Tl 冲洗的评估可以在这些情况下提供诊断帮助，因为冲洗分析在空间上不相关并且灌注不足的心肌区域表现出缓慢的 201Tl 冲洗率。在对 1265 名连续患者进行了应力再分布闪烁扫描定量分析后，46 名患者出现弥漫性缓慢冲洗模式，没有或最多有 1 个区域灌注缺陷。 32 例接受了临床指示的冠状动脉造影，其中 23 例 (72%) 被发现患有 3 支血管或左主干疾病。在 30 名没有弥漫性缓慢冲洗模式且没有或最多有 1 处灌注缺损的类似患者中，只有 5 名 (17%) 患有广泛的冠状动脉疾病。通过对广泛疾病的多种其他指标进行 Mantel-Haentzel 卡方分析，证明了弥漫性缓慢冲洗与广泛冠状动脉疾病之间的独立关系。即使没有其他闪烁扫描、临床或心电图指标，弥漫性冲洗异常也对三支血管或左主干冠状动脉疾病具有很高的预测价值。当达到的运动水平低于最大水平时，预测值得以维持。虽然这种情况很少见（受测患者的 3.6%），但弥漫性缓慢冲洗模式没有广泛冠状动脉疾病的其他闪烁显像迹象，应进行进一步的诊断测试。
When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of 201Tl from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow 201Tl washout rate. In 1265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of 1 regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have 3 vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of 1 perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or ECG indicators, carries a high predictive value for 3 vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is submaximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.