Japanese
Title虚血性心疾患の診断と運動負荷時心筋タリウムWashout Rate - Washout Rateに影響する因子 -
Subtitle原著
Authors成田充啓*, 栗原正*, 村野謙一*, 宇佐美暢久*, 本田稔**, 友延正弘**, 金尾啓右**
Authors(kana)
Organization*住友病院内科, **アイソトープ室
Journal核医学
Volume25
Number2
Page141-150
Year/Month1988/2
Article原著
Publisher日本核医学会
Abstract「要旨」運動負荷201Tl心筋SPECTを負荷直後と3時間後の再分布時に行い, 心筋虚血以外にTl washout rate(WOR)に影響する因子を健常例(20例)で検討, この結果を冠動脈疾患(CAD, 159例)に応用した. 健常例で性, 心筋部位はTl WORに影響しなかったが, 運動負荷量(Tl静注時心拍数), 負荷時肺心筋Tl摂取比(L/M)はWORとおのおの相関係数r=0.71, r=-0.57(ともにp<0.01)とWORに影響した. また健常例のWORのデータやCADにおける応用よりWORの異常(<30%)を心筋虚血の診断基準として使用するのはTl静注時心拍数が110/分以上の症例に限るのが適切と思えた. また負荷時心拍数が110/分を超えたCADにおいてL/Mが0.45以上の症例は正常冠動脈支配域でもWORの低下を示した. 運動負荷量, L/Mを考慮したWORのCADにおける応用はspecificityを損うことなく, 狭窄冠動脈の診断率を71%から79%へと有意(p<0.01)に向上した. 以上より心筋虚血の診断基準にWORを使用する際, 運動負荷量, L/Mの考慮が必要である.
Practice臨床医学：一般
KeywordsExercise stress myocardial SPECT, Washout rate, Exercise heart rate, Lung to myocardial Tl-201 uptake ratio.
English
TitleFactors Affecting Myocardial Thallium-201 Washout Rate after Exercise Stress and their Significance for the Detection of Coronary Artery Disease
SubtitleOriginal Articles
AuthorsMichihiro NARITA*, Tadashi KURIHARA*, Kenichi MURANO*, Masahisa USAMI*, Minoru HONDA**, Masahiro TOMONOBU**, Keisuke KANAO**
Authors(kana)
Organization*Department of Internal Medicine, Sumitomo Hospital, **Department of Nuclear Medicine, Sumitomo Hospital
JournalThe Japanese Journal of nuclear medicine
Volume25
Number2
Page141-150
Year/Month1988/2
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] Quantitative analysis of exercise stress (Ex) and redistribution Tl-201 myocardial tomography is useful for the detection of coronary artery disease (CAD). We studied the factors which influence myocardial Tl washout rate (WOR) after Ex and their significance for the detection of CAD. Myocardial tomograms were obtained both at immediately after Ex and 3 hours later by using a rotating gamma camera in 20 normal subjects and 159 patients with CAD. After low-pass filtering, images were reconstructed into short-axis, horizontal long-axis and vertical long-axis tomograms and they were used for visual interpretation. By using short-axis tomograms, WOR's of the entire left ventricle were expressed as 2-dimensional polar map (Bull's-eye map). In normal subjects, WOR's were influenced by the strength of Ex (heart rate, HR) (r=0.71, p<0.01) and lung to myocardial Tl uptake ratio at Ex (L/M) (r=-0.57, p<0.01), but difference of myocardial segments and sex did not influence to WOR,s. Normal lowest limits of WOR were established as 30% from the data of normal subjects. When we added abnormal WOR (<30%) as a criteria of myocardial ischemia to the visual interpretation in patients with CAD with inadequate Ex (HR<110 bpm, n=17), the specificity for the detection of coronary artery (CA) stenosis decreased significantly (from 100% to 44%, p<0.05) without improving sensitivity. In 142 patients with CAD with adequate Ex (HR>=110 bpm), 6 patients showed abnormal WOR's in myocardial segments which were supplied by normal CA and they all showed abnormally high L/M (>=0.45). When we apply abnormal WOR to detect myocardial ischemia, we should take account of HR at Tl injection and L/M, and the consideration of these 2 factors improved the sensitivity to detect CA stenosis from 71% (visual interpretation) to 79% (p<0.01) without missing specificity.
PracticeClinical medicine
KeywordsExercise stress myocardial SPECT, Washout rate, Exercise heart rate, Lung to myocardial Tl-201 uptake ratio.

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