Characterization of the functional significance of subcritical coronary stenoses with H(2)15O and positron-emission tomography.
Characterization of the functional significance of subcritical coronary stenoses with H(2)15O and positron-emission tomography.
复制标题
用 H(2)15O 和正电子发射断层扫描表征亚临界冠状动脉狭窄的功能意义。
DOI：
10.1161/01.cir.71.6.1271
复制
发表时间：
1985
期刊：
影响因子：
37.8
通讯作者：
Bergmann,SR
中科院分区：
文献类型：
--
作者：
Knabb,RM;Fox,KA;Sobel,BE;Bergmann,SR
我们之前已经开发出一种方法，使用15O(半衰期2.1min)标记水(H2(15)O)的心脏正电子发射断层扫描(PET)和C15O的血池减影来评估心肌灌注。这项研究是为了确定所开发的方法是否可以检测到血管扩张剂应激引起的血流差异，表明尽管静息状态下血流正常，但功能上存在显著的亚临界冠状动脉狭窄。在开胸犬冠状动脉左前降支放置一个小的聚四氟乙烯圆柱体，造成冠状动脉狭窄。静脉注射H(2)15O，吸入C15O，断层扫描测定局部心肌血流量。静息状态下，狭窄远端血流正常。然而，在直径为50%到70%的狭窄远端区域，持续检测到对潘生丁充血反应的显著降低。潘生丁对狭窄远端血流的绝对值增加了一倍以上，但仅为同一只狗正常区域或正常狗相应前部血流增加的43+/-9%。PET无创性测量的相对心肌血流量与体外测量的放射性标记微球的分布密切相关(r=0.88)。因此，在静息状态和血管扩张剂诱导的应激过程中，用H(2)15O和正电子发射计算机断层扫描(PET)评估犬的心肌血流量，可以检测到明显的生理性冠状动脉狭窄。因此，该程序在诊断患者冠状动脉功能不全以及评估旨在增强区域血流灌注的临床干预措施方面应该是有用的。
We have previously developed a method employing cardiac positron-emission tomography (PET) with 15O (half-life 2.1 min)-labeled water (H2(15)O) and blood pool subtraction with C15O for assessment of myocardial perfusion. This study was performed to determine whether the method developed permits detection of the differences in blood flow, induced by vasodilator stress, indicative of functionally significant subcritical coronary stenosis despite normal perfusion at rest. Coronary stenoses were induced with a small Teflon cylinder placed in the left anterior descending coronary artery of the closed-chest dog. Regional myocardial blood flow was assessed tomographically with H(2)15O given intravenously and C15O given inhalation. Blood flow distal to the stenoses was normal under conditions of rest. However, significant reductions in the hyperemic response to dipyridamole were detected consistently in regions distal to 50% to 70% diameter stenoses. Flow distal to stenoses more than doubled in absolute terms in response to dipyridamole but was only 43 +/- 9% of the increased flow in normal regions in the same dogs or in corresponding anterior regions in normal dogs. Relative myocardial blood flow measured noninvasively with PET correlated closely with the distribution of radiolabeled microspheres measured in vitro (r = .88). Thus, assessment of myocardial blood flow with H(2)15O and PET in dogs at rest and during vasodilator-induced stress permits detection of physiologically significant coronary stenoses. The procedure should therefore prove useful diagnostically for the detection of coronary insufficiency in patients as well as for the assessment of clinical interventions designed to augment regional perfusion.