Fatty Acid Metabolism and Perfusion Mismatch in Acute Chest Pain Syndrome
Fatty Acid Metabolism and Perfusion Mismatch in Acute Chest Pain Syndrome
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急性胸痛综合征中的脂肪酸代谢和灌注不匹配
DOI：
10.17996/anc.01.01.95
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
K. Yoshinaga
中科院分区：
文献类型：
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作者：
J. Ohata;S. Shibata;K. Yoshinaga
一位70岁女性于2014年3月20日因疑似急性心肌梗死入住我院。她的家庭医生诊所的心电图显示导联V1和V2 ST段抬高（图1）。急诊冠状动脉造影（CAG）显示冠状动脉正常。然而，左心室造影（LVG）显示前间隔室壁运动严重减少（图2）。LVG未见心尖部气球样变。次日心电图V1 ~ V5导联T波倒置。胸痛发作后12小时，肌酐激酶峰值为153 IU/L。入院后5天，患者进行静息核心脏成像。静息铊显示静息时灌注正常。而其余123个I-β-甲基-对碘苯基-十五烷酸（BMIPP）在隔前显示中等强度的缺损（图3）。因此，在前部存在灌注和脂肪酸不匹配。123 I BMIPP的结果与ECG改变和LVG结果一致。虽然我们没有进行乙酰胆碱激发，但急性胸痛综合征可能与血管痉挛性心绞痛有关（1，2）。Takotubo心肌病也是这种胸痛综合征的另一个可能原因（3）。然而，LVG的结果并不符合典型的心尖气球样变的模式。在当前病例中，IBMIPP可能准确检测与急性胸痛综合征相关的顿抑心肌（1、2、4、5）。核心脏病学年鉴第1卷第1期95-97
A 70 year old woman was admitted to our hospital on March 20, 2014 due to suspected acute myocardial infarction. Her ECG showed ST elevation in lead V1 and V2 at her family physician7s clinic(Fig. 1). Emergency coronary angiography(CAG)showed normal coronary. However, left ventriculography(LVG)showed severely reduced wall motion in anteroseptum(Fig. 2). LVG did not show apical ballooning. The ECG showed inverted T waves in lead V1 to V5 on next day. Peak creatinine kinase was 153 IU/L at 12 hours after the onset of chest pain. Five days after the admission, the patient had rest nuclear cardiology imaging. Rest thallium showed normal perfusion at rest. In contrast, rest 123 Ibetamethyl-p-iodophenyl-pentadecanoic acid (BMIPP)showedmoderate intensity of defect in anterior to septum(Fig. 3). Thus, there was perfusion and fatty acid mismatch in anterior. This 123 I BMIPP finding agreed with ECG changes and LVG findings. Although, we did not perform acetylcholine provocation, the acute chest pain syndrome might be associated with vasospastic angina(1,2). Takotubo cardiomyopathy was also another possible causes of this chest pain syndrome(3). However, LVG findings did not agree with the typical apical ballooning pattern. In the current case, I BMIPP might accurately detect stunned myocardium related to acute chest pain syndrome(1,2,4,5). Annals of Nuclear Cardiology Vol. 1 No. 1 95-97