Japanese
Title陳旧性前壁梗塞におけるU波の意義に関する核医学的検討
Subtitle原著
Authors兼本成斌*, 今岡千栄美*, 五島雄一郎*, 鈴木豊**
Authors(kana)
Organization*東海大学医学部内科, **放射線科
Journal核医学
Volume25
Number2
Page133-139
Year/Month1988/2
Article原著
Publisher日本核医学会
Abstract「要旨」陳旧性前壁梗塞(PAMI)において左胸部誘導に示される陰性U波の意義を明らかにすることを目的とした. 対象はPAMI 63例(男性58例, 女性5例, 平均年齢51.7歳)で, V4〜6誘導のU波の極性により, 陽性U波(PU群, 16例), 平坦U波(FU群, 18例), 陰性U波(NU群, 29例)の3群に分類した. 正常対照(NL)として心肺に異常のない12例(男性7例, 女性5例, 平均年齢49.3歳)を供した. 方法は, 心電図のQ波数, 運動負荷201Tl心筋シンチグラフィから総心筋灌流指数(TMPI), 99mTc心プールシンチグラフィにより安静時および運動負荷中の全体および区域駆出率(GEFおよびREF)を求め比較検討した. その結果, 異常Q波数はPU群1.6±1.5に比べFU群3.6±0.7, NU群4.3±1.3と後2者に多かった(ともにp<0.001). TMPIはPU→FU→NU群の順に各群間で有意差をもって減少(それぞれp<0.001, p<0.02)した. 運動負荷直後における前側壁の心筋灌流指数もこの順に有意差をもって減少したが, NU群のみは4時間後に明らかな再分布が示され, FU群との間に有意差が消失した. 安静時のGEFはNL 63.9±8.6%, PU群65.0±11.8%, FU群53.6±8.1%, NU群36.5±13.6%と, NLとPU群の間に有意差はなかったが, 以下PU→FU→NU群の順に各群間で有意差が示された(それぞれp<0.005, p<0.001). 前壁中隔, 下壁心尖部のREFも同様の傾向があった. しかし, 後側壁はNU群のみが明らかに低下し, 運動負荷によってさらに低下する症例が少なくなかった. 以上よりPAMIにおける左胸部誘導の陰性U波は, 心尖部を含む広範な梗塞で, 著しい左室機能の低下を示唆する指標であることが明らかにされ, 側壁領域の虚血を反映することが推察された.
Practice臨床医学：一般
KeywordsNegative U wave, Previous anterior infarction, Tl-201 myocardial scintigraphy, Tc-99m ventriculography.
English
TitleRadionuclide Evaluations on Significance of U Waves in Previous Anterior Myocardial Infarction
SubtitleOriginal Articles
AuthorsNariaki KANEMOTO*, Chiemi IMAOKA*, Yuichiro GOTO*, Yutaka SUZUKI**
Authors(kana)
Organization*Department of Internal Medicine, **Department of Radiology, Tokai University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume25
Number2
Page133-139
Year/Month1988/2
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] The aim of this study is to evaluate the clinical significance of negative U waves in patients with previous anterior myocardial infarction. Subjects were 63 patients (58 men and 5 women, mean age of 51.7 years). They were divided into three groups according to the polarity of U waves in left precordial leads (leads V4-6): positive U waves (PU) of 16 patients, flat U waves(FU)of 18 patients and negative U waves (NU) of 29 patients. Twelve normals (7 men and 5 women, average age of 49.3 years) were studied as controls. Stress 201Tl-myocardial scintigraphy (TMS) and ECG-gated-99mTc-radionuclide ventriculography (RNVG) at rest and during exercise were performed. Total myocardial perfusion index (TMPI) was calculated as follows; each scintigram (anterior, LAO 45°and LAO 70°views) was divided into roughly equal 5 segments, and the perfusion of each segment was graded visually from 0 (no perfusion) to 3 (normal perfusion). TMPI was a sum of each score from 3 views. Global-ejection fraction (GEF) and regional-ejection fraction (REF) in anteroscptal (AS), apicoinferior (AI) and posterolateral (PL) segments were calculated at rest and during submaximal exercise. TMPI decreased from PU, FU to NU with significant difference (p<0.001, p<0.02, respectively). MPI in anterolateral segment immediately after exercise showed the same tendency. However, significant redistribution was noted in NU and hence MPI showed no changes with FU in delayed images. GEF at rest was 63.9 +- 8.6% in normals,65.0 +- 11.8% in PU,53.6 +- 8.1% in FU and 36.5 +- 13.6% in NU. However, significant differences were shown between PU and FU (p<0.005), and FU and NU (p<0.001), Regional EF in anteroseptal and apicoinferior segments showed the same tendencies. However, in posterolateral segment REF in only NU showed the significantly lower value and decreased further during exercise. These results suggest that negative U waves of left precordial leads in previous anterior myocardial infarction are the important sign suggesting extensive myocardial infarction with significantly decreased left ventricular function involving the apex. Negative U waves could be censidered to be connecting with lateral ischemia.
PracticeClinical medicine
KeywordsNegative U wave, Previous anterior infarction, Tl-201 myocardial scintigraphy, Tc-99m ventriculography.

【全文PDF】