MYOCARDIAL ISCHEMIA AND HYPERTROPHIC CARDIOMYOPATHY

心肌缺血和肥厚性心肌病

• 批准号: 3858114
• 负责人: R O CANNON
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3858114
• 关键词: exercise; heart catheterization; heart circulation; heart disorder diagnosis; heart imaging /visualization /scanning; heart output disorder; hemodynamics; human subject; hypertrophic myocardiopathy; intracardiac pressure; myocardial ischemia /hypoxia; myocardium disorder; radionuclide diagnosis; vasodilation

Exercise-induced abnormalities during thallium-201 scintigraphy that normalize at rest frequently occur in patients with hypertrophic cardiomyopathy. Because it is not known whether these abnormalities are indicative of myocardial ischemia, 50 patients with hypertrophic cardiomyopathy underwent exercise thallium scintigraphy and, during the same week, measurement of myocardial lactate metabolism and hemodynamics during pacing stress. Of the 37 patients with reversible thallium abnormalities, 27 (73%) had metabolic evidence of myocardial ischemia during rapid atrial pacing compared with 4 of 13 patients (31%) with normal thallium scans (p>0.01). Eleven patients had apparent cavity dilatation as their only thallium abnormality; their mean post-pacing left ventricular end-diastolic pressure significantly higher than that of the 13 patients with normal thallium studies (33-/+5 vs 21+/-10 mmHg, p>0.001). There was no correlation between angiographic presence of systolic septal or epicardial coronary artery compression and the presence or distribution of thallium abnormalities. We conclude that reversible thallium abnormalities during exercise stress are markers of myocardial ischemia in hypertrophic cardiomyopathy and most likely identify relatively underperfused myocardium. Apparent cavity dilatation during thallium scintigraphy may indicate ischemia-related changes in left ventricular filling, with elevation in diastolic pressures and endocardial compression.

在铊-201放射性造影术中， 在休息时恢复正常经常发生在肥厚性心肌病患者中， 心肌病 因为不知道这些异常是否 提示心肌缺血，50例肥厚型 心肌病患者接受了运动铊造影术， 同一周，测量心肌乳酸代谢和血流动力学 在起搏压力下。 在37例可逆性铊中毒患者中， 27例（73%）有心肌缺血的代谢证据 快速心房起搏组13例中有4例（31%） 铊扫描（P>0.01）。 11例患者有明显的空洞扩张 作为他们唯一的铊异常;他们的平均起搏后左心室 舒张末压明显高于13例患者 正常铊研究（33-/+5 vs 21+/-10 mmHg，p>0.001）。有 血管造影显示收缩期间隔或 心外膜冠状动脉压迫和存在或分布 铊异常 我们的结论是可逆的铊异常 运动应激是心肌肥厚患者心肌缺血的标志 心肌病和最有可能识别相对灌注不足 心肌 在铊造影过程中明显的空洞扩张可能 表明左心室充盈的缺血相关变化， 舒张压升高和血管内膜压缩。