INCREASED LUNG UPTAKE OF TL-201 DURING EXERCISE MYOCARDIAL IMAGING - CLINICAL, HEMODYNAMIC AND ANGIOGRAPHIC IMPLICATIONS IN PATIENTS WITH CORONARY-ARTERY DISEASE
INCREASED LUNG UPTAKE OF TL-201 DURING EXERCISE MYOCARDIAL IMAGING - CLINICAL, HEMODYNAMIC AND ANGIOGRAPHIC IMPLICATIONS IN PATIENTS WITH CORONARY-ARTERY DISEASE
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DOI：
10.1016/0002-9149(80)90057-0
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发表时间：
1980-01-01
影响因子：
2.8
通讯作者：
POHOST, GM
中科院分区：
文献类型：
--
作者：
BOUCHER, CA;ZIR, LM;POHOST, GM
为了确定运动应激后即刻肺中铊-201活性增加的临床意义，回顾了227例接受心导管插入术的患者的铊-201扫描。初始前视图图像上的铊肺活动定性分级如下：175例患者为0（无）（77%）; 1+（肺活动中度增加，但强度低于左心室心肌）2+（严重活动强度等于或大于左室心肌活动强度）15例（7%）。肺活动增加（1+或2+）与（1）心肌节段性铊缺陷数量增加（概率[p] < 0.05）;（2）冠状动脉疾病的严重程度和范围增加（p < 0.05）有关。此外，2+肺铊活性与：（1）既往心肌梗死的患病率较高（p < 0.01）;（2）静息时血管造影射血分数较低（p < 0.05）相关。为了确定与铊-201的肺摄取增加相关的血流动力学变化，在另外12名患者的心导管插入术期间进行仰卧位负荷铊成像。其中，铊扫描显示肺活动增加的5名患者的平均肺毛细血管楔压随运动从12 ± 1（平均值± 1标准差）增加到24 ± 3 mm Hg（p < 0.05）;心脏指数不随应激增加。相反，7名肺铊活性未增加的患者表现出平均心脏指数增加（p < 0.05），而肺毛细血管楔压无相关升高（静息时= 10 ± 3 mm Hg;应激时= 12 ± 2 mm Hg）。总之，运动铊-201显像期间肺摄取增加提示运动诱发的左心室功能障碍的发展。运动铊-201心肌显像研究的常规解释中应增加肺活动的评价。
To determine the clinical significance of increased thallium-201 activity in the lung immediately after exercise stress, the thallium-201 scans in 227 patients undergoing cardiac catheterization were reviewed. Thallium lung activity on the Initial anterior view images were graded qualitatively as follows: 0 (none) in 175 patients (77 percent); 1+ (moderate—increased activity in the lungs but less intense than that in left ventricular myocardium) in 37 patients (16 percent); and 2+ (severe—activity equal to or greater in intensity than left ventricular myocardlal activity) in 15 patients (7 percent). Increased (1+ or 2+) lung activity was related to (1) a greater number of myocardial segmental thallium defects (probability [p] < 0.05); and (2) increased severity and extent of coronary artery disease (p < 0.05). In addition, 2+ lung thallium activity was associated with: (1) a greater prevalence of prior myocardial infarctions (p < 0.01); and (2) a lower angiographic ejection fraction at rest (p < 0.05). To determine the hemodynamic changes associated with increased lung uptake of thallium-201, supine stress thallium imaging was performed during cardiac catheterization in 12 additional patients. Of these, the five patients with increased lung activity on thallium scanning had a mean pulmonary capillary wedge pressure that increased with exercise from 12 ± 1 (mean ± 1 standard deviation) to 24 ± 3 mm Hg (p < 0.05); cardiac index did not increase with stress. In contrast, seven patients without increased lung thallium activity demonstrated an increase in mean cardiac index (p < 0.05) without an associated rise in pulmonary capillary wedge pressure (at rest = 10 ± 3 mm Hg; during stress = 12 ± 2 mm Hg). In conclusion, increased pulmonary uptake during exercise thallium-201 imaging suggests the development of exercise-induced left ventricular dysfunction. Evaluation of lung activity should be added to the routine interpretation of exercise thallium-201 myocardial imaging studies.