CONGESTIVE HEART FAILURE--NUCLEAR STUDIES

铊和FDG PET提供增强的生存能力信息 经食道多巴酚丁胺超声心动图识别冬眠 心肌 在有预留心肌血流量的无节律心肌区 (MBF)静息时，小剂量的收缩储备可能会显露出来 多巴酚丁胺。然而，在慢性疾病导致功能障碍的区域 低灌注率，我们假设给药呈阳性 正性肌力药(即使在低剂量下)可能会引起心肌缺血和 持续的区域功能障碍。以确定铊(Tl)是否 闪烁成像和正电子发射断层扫描(PET)提供了更多 多巴酚丁胺(D)经食道给药后的生存信息 超声心动图(TEE)，我们研究了10例慢性冠心病患者和 静息时左心功能受损(LVEF为11%~44%，平均为30%)。 所有患者均接受了基线和D-TEE，应力重分布-再注射 N-13氨水和F-18脱氧葡萄糖热释光成像及静息PET (FDG)。对于每个患者，左室被分成12个区域和D-TEE， 比较热释光和正电子发射计算机断层扫描的数据。计算绝对MBF(毫升/克/分钟) 一个单一的大区域，在其中氨的吸收是均匀的和所有其他的 然后根据该MBF值对区域进行缩放。在78个地区中 减少MBF(0.7ml/g/min)和静息不耐力，41(53%)改善 在D-T形三通期间。41人中的39人(95%)被确认为可行的两者 由TL和PET检测。然而，在37个没有改善的地区中， 在D-TEE中，16例(43%)有正常或可逆性TL缺陷，21例有 不可逆性TL缺损者(7例轻中度，14例重度)。宠物已确认 在16个TL可行区域中有15个具有生存能力。此外，PET 发现存活心肌(FDG：MBF不匹配)5/14(36%)严重 不可逆的TL缺陷。这些数据表明，在非同步能区 静息时血流异常(冬眠心肌)，当 有D-TEE的收缩储备，心肌存活 不需要对TL和/或PET进行既定的和额外的测试。 然而，在缺乏D-TEE、TL和FDG收缩储备的情况下 PET提供有关心肌梗死的重要附加信息 生存能力。

Thallium and FDG PET Provide Incremental Viability Information to Transesophageal Dobutamine Echocardiography for Identifying Hibernating Myocardium In asynergic myocardial regions with preseved myocardial blood flow (MBF) at rest, contractile reserve may be unmasked by low-dose dobutamine. However, in regions rendered dysfunctional by chronic hypoperfusion, we hypothesized that the administration of a positive inotropic agent (even at low doses) may produce myocardial ischemia and persistent regional dysfunction. To determine whether thallium (Tl) scintigraphy and positron emission tomography (PET) provide additional viability information beyond that of dobutamine (D) transesophageal echocardiography (TEE), we studied 10 patients with chronic CAD and impaired LV function at rest (LVEF ranged from 11 to 44%, mean = 30%). All pts underwent baseline and D-TEE, stress-redistribution-reinjection Tl imaging and PET at rest using N-13 ammonia and F-18 deoxyglucose (FDG). For each patient, the LV was divided into 12 regions and D-TEE, Tl and PET data were compared. Absolute MBF (ml/g/min) was computed for a single large region in which ammonia uptake was uniform and all other regions were then scaled by this MBF value. Among 78 regions with reduced MBF (<0.7 ml/g/min) and asynergy at rest, 41 (53%) improved during D-TEE. Thirty-nine of the 41 (95%) were confirmed as viable both by Tl and PET. However, among the 37 regions that did not improve during D-TEE, 16 (43%) had normal or reversible Tl defects and 21 had irreversible Tl defects (7 mild-moderate and 14 severe). PET confirmed viability in 15 of the 16 Tl viable regions. In addition, PET identified viable myocardium (FDG:MBF mismatch) in 5 of 14 (36%) severe irreversible Tl defects. These data suggest that in asynergic regions with abnormal blood flow at rest (hibernating myocardium), when contractile reserve with D-TEE is present, myocardial viability is established and additional testing with Tl and/or PET is not required. However, in the absence of contractile reserve with D-TEE, Tl and FDG PET provide significant additional information regarding myocardial viability.