Myocardial salvage by intracoronary thrombolysis in evolving acute myocardial infarction: evaluation using intracoronary injection of thallium-201.
Myocardial salvage by intracoronary thrombolysis in evolving acute myocardial infarction: evaluation using intracoronary injection of thallium-201.
复制标题
急性心肌梗死进展中通过冠状动脉溶栓挽救心肌：使用冠状动脉注射铊 201 进行评估。
DOI：
10.1016/0002-8703(81)90091-0
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发表时间：
1981
影响因子：
4.8
通讯作者：
Berman,DS
中科院分区：
文献类型：
--
作者：
Maddahi,J;Ganz,W;Ninomiya,K;Hashida,J;Fishbein,MC;Mondkar,A;Buchbinder,N;Marcus,H;Geft,I;Shah,PK;Rozanski,A;Swan,HJ;Berman,DS
由于功能恢复延迟，通过评估心室功能对冠状动脉内（IC）溶栓后再灌注心肌的活力进行立即客观评估可能会受到限制。因此，我们评估了 12 只实验狗和 5 名患有急性心肌梗塞 (AMI) 的患者在再灌注后 IC 注射后心肌对铊 201 (TI-201) 的摄取，作为心肌挽救的指标。在七只狗中，实验性冠状动脉闭塞平均时间为 313 分钟，再灌注后立即 IC TI-201 图像显示先前闭塞区域没有心肌摄取。这些 TI-201 缺陷与坏死的存在相关，如三苯基氯化四唑 (TTC) 的组织化学染色所证明的。相比之下，在平均冠状动脉闭塞时间为 37 分钟的五只狗中，注射 IC 后，再灌注心肌显示出正常的 TI-201 摄取；通过 TTC 技术，在所有五只狗中，这种正常的 TI-201 摄取模式与没有坏死相关。在五名患有进展性 AMI 的患者中，IC 溶栓前静脉注射后获得的对照 TI-201 图像显示与闭塞血管分布相对应的心肌灌注缺陷。再灌注后，将 30 至 50 mCi 的 TI-201 注射到重新开放的冠状动脉中。在两名平均再灌注时间为 2·1·2 小时出现症状的患者中，再灌注后即刻的 IC TI-201 图像显示再灌注心肌中 TI-201 的摄取正常或改善。通过放射性核素心室造影，再灌注后 6 小时，再灌注区域的节段性室壁运动仍然异常，并且在 10 天的研究中显示出改善。其余三名症状出现至再灌注时间为 5 小时的患者中，再灌注后立即 IC TI-201 图像未显示改善，这与再灌注后 10 天持续性室壁运动异常相关。在所有五名患者中，重复 10 天 IV TI-201 图像与再灌注后立即 IC TI-201 图像没有变化。我们得出的结论是：（1）再灌注前 TI-201 成像，重复将 TI-201 注射到重新开放的冠状动脉中，似乎可以在实验和临床研究中描述心肌挽救的程度；（2）这种 IC TI-201 成像方法可以立即评估心肌活力，这可能有助于决定是否需要额外的心肌血运重建方式。
Immediate objective assessment of viabillty of reperfused myocardium following intracoronary (IC) thrombolysis by evaluation of ventricular function may be limited due to delay in restoration of function. Thus we assessed myocardial uptake of thallium-201 (TI-201) following IC injection postreperfusion as an index of myocardial salvage in 12 experimental dogs and in five patients with evolving acute myocardial infarction (AMI). In seven dogs with mean of 313 minutes of experimental coronary occlusion, immediate postreperfusion IC TI-201 images revealed absence of myocardial uptake in prevlously occluded zones. These TI-201 defects correlated with presence of necrosis as demonstrated by histochemical staining with triphenyl-tetrazolium chloride (TTC). In contrast, in five dogs with mean of 37 minutes of coronary occlusion, reperfused myocardium showed normal TI-201 uptake following its IC injection; this normal TI-201 uptake pattern correlated with absence of necrosis by TTC technique in all five dogs. In five patients with evolving AMI, control TI-201 images obtained following IV injection prior to IC thrombolysis showed myocardial perfusion defects corresponding to distribution of the occluded vessel. Following reperfusion, 30 to 50 mCi of TI-201 was injected into the reopened coronary artery. In two patients with mean symptom onset of reperfusion time of 2 1 2 hours, immediate postreperfusion IC TI-201 images demonstrated normal or improved TI-201 uptake in reperfused myocardium. By radionuclide ventriculography, segmental wall motion remained abnormal in the reperfused regions 6 hours postreperfusion and showed improvement by the time of 10-day study. In the remaining three patients with symptom onset to reperfusion time of 5 hours, immediate postreperfusion IC TI-201 images did not show improvement, correlating with persistent wall motion abnormalities 10 days postreperfusion. In all five patients, repeat 10-day IV TI-201 images were unchanged from the immediate postreperfusion IC TI-201 images. We conclude that (1) prereperfusion TI-201 imaging with repeat TI-201 injection into the reopened coronary artery appears to delineate the extent of myocardial salvage in both experimental and clinical studies and (2) this method of IC TI-201 imaging allows immediate assessment of myocardial viabillty which may facilltate decisions regarding the need for additional myocardial revascularization modalities.