Japanese
Title心プールシンチグラフィによるPostextrasystolic Potentiationの評価が梗塞部残余心筋の推定に有用であった一例
Subtitle症例報告
Authors石田良雄*, 谷明博*, 両角隆一*, 松原昇*, 堀正二*, 北畠顕*, 鎌田武信*, 木村和文**, 小塚隆弘**, 中土義章***, 南野隆三***
Authors(kana)
Organization*大阪大学医学部第一内科, **中央放射線部, ***桜橋渡辺病院循環器内科
Journal核医学
Volume26
Number3
Page425-431
Year/Month1989/3
Article報告
Publisher日本核医学会
Abstract「要旨」 病歴に胸痛症状を欠いたが, CAGで右冠動脈 (90%狭窄) および左回旋枝 (99%狭窄) の病変が認められ, またLVGで下壁および後壁がakinesisを示したsilent ischemiaの一例 (73歳, 男性). 心不全が強いため, PTCAによる虚血部心筋の収縮改善を期して, 核医学的検査によるPTCAの適応の検討が行われた. 運動負荷/再分布201T1心筋SPECTにおいて, 下壁の一部に再分布が認められた. さらに, 本症例は, 心室性期外収縮による四段脈が連続していたので, 心プールシンチグラフィ (リスト・モード収集法) によるPostextrasystolic Potentiation (PESP) の解析を行い, 下壁収縮の増強と左室駆出率 (EF) の36%から45%への上昇をみた. 以上より下壁心筋のviabilityが推定されたため, 右冠動脈にPTCAを施行し, 術後下壁収縮の改善とEFの改善 (54%) が得られた. PESPが, PTCAの適応の決定と効果の予測に有効であった一例である.
Practice臨床医学：一般
KeywordsMyocardial viability, Postextrasystolic potentiation, Exercise-redistribution thallium-201 SPECT, PTCA, Silent ischemia
English
TitleEstimation of Myocardial Viability in Left Ventricular Regions with Akinetic Wall Motion by Postextrasystolic Potentiation Using List-mode Radionuclide Ventriculography in an Interesting Case with Silent Ischemia and with Premature Ventricular Complexes (quadrigeminy)
Subtitle
AuthorsYoshio ISHIDA*, Akihiro TANI*, Ryuichi MOROZUMI*, Noboru MATSUBARA*, Masatsugu HORI*, Akira KITABATAKE*, Takenobu KAMADA*, Kazufumi KIMURA**, Takahiro KOZUKA**, Yoshiaki NAKATSUCHI***, Takazo MINAMINO***
Authors(kana)
Organization*The First Department of Medicine, **Division of Nuclear Medicine, Osaka University Medical School, ***Sakurabashi-Watanabe Hospital
JournalThe Japanese Journal of nuclear medicine
Volume26
Number3
Page425-431
Year/Month1989/3
ArticleReport
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] For determining an indication of percutaneous transluminal angioplasty (PTCA) , a 73-year-oldman with silent ischemia and with ventricular premature complexes (quadrigeminy) were performed cardiac nuclear studies. This case had 99% stenosis in LCX (#11) and 90% stenosis in RCA (#1) , and demonstrated akinetic wall motion in left ventricular (LV) inferior and posterior regions. Exercise-redistribution T1-201 studies indicated myocardial viability in a portion of the inferior wall but not in the posterior wall. To estimate the potential contractile function in the regions with akinesis, from the list-mode data of radionuclide ventriculography, those of postsinus beats and postextrasystolic beats were separately selected and were analyzed for investigating LV wall motion and LV ejection fraction (EF) . With the postextrasystolic potentiation, LVEF increased from 36% to 45% and the systolic wall motion was augmented in the inferior wall but not in the posterior wall. From these findings we recognized the existence of myocardial viability in a portion of the inferior wall. After PTCA for the RCA lesion, improvements of the myocardial T1-201 distribution and LV wall motion in the inferior wall were definitely observed and hence LVEF increased by 16% to contribute to an increase in exercise performance. Thus, this case indicates that the postextrasystolic potentiation is useful for determining an indication of PTCA in patients with LV asynergy, demonstrating the myocardial viability and the potential LV function.
PracticeClinical medicine
KeywordsMyocardial viability, Postextrasystolic potentiation, Exercise-redistribution thallium-201 SPECT, PTCA, Silent ischemia

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