Japanese
Title冠動脈疾患のない左脚ブロックにおける心筋灌流
Subtitle原著
Authors成田充啓*, 栗原正*, 村野謙一*, 宇佐美暢久*, 本田稔**
Authors(kana)
Organization*住友病院内科, **アイソトープ検査部
Journal核医学
Volume29
Number4
Page435-442
Year/Month1992/4
Article原著
Publisher日本核医学会
Abstract「要旨」冠動脈疾患(CAD)のない左脚ブロック(LBBB)を対象に運動負荷201Tl心筋イメージングを行い, LBBBにおける灌流異常の出現頻度, その特徴を検討した. 対象は冠動脈に狭窄のないLBBB23例と中隔に一過性灌流異常をきたしたCAD(前下行枝病変)9例で, 運動負荷時, 再分布時に201Tl心筋イメージング(断層像)を撮像した. LBBB23例中15例(65%)で運動負荷により灌流異常をきたした. このうち10例(67%)では中隔全域に再分布を伴う一過性欠損(diffuse type)をきたしたが, 5例(33%)では中隔と前壁との境界部に, 比較的限局した固定性欠損(focal type)をきたし, CADのないLBBBで, 運動負荷心筋イメージングで生じる欠損が単一でないことを示した. Focal typeではLBBB正常灌流群, diffuse typeと異なり高血圧, 大動脈弁狭窄, sick sinus syndromeといった併存する疾患が全例で存在し, focal typeとdiffuse typeでは欠損の出現するメカニズムも異なっているのではないかと考えられた. LBBB diffuse typeとCADの鑑別においては, 欠損の広がりそのものは両者で差を見なかったが, LBBBではCADと異なり心尖部欠損の出現が少ないこと(20% vs. 89%, p<0.05)や, 最小201Tl washout rate, 中隔・側壁201Tl取り込み比がLBBBでCADより有意(p<0.01)に高いこと, すなわちLBBBではCADより運動負荷で出現した虚血の程度が軽度であることより, 両者の鑑別がイメージ上もある程度可能と考えられた.
Practice臨床医学：一般
KeywordsLeft bundle branch block, Septal defect, Myocardial tomography with 201Tl, Coronary artery disease.
English
TitleMyocardial Perfusion in Patients with Left Bundle Branch Block and without Coronary Artery Disease
SubtitleOriginal Article
AuthorsMichihiro NARITA*, Tadashi KURIHARA*, Kenichi MURANO*, Masahisa USAMI*, Minoru HONDA**
Authors(kana)
Organization*Department of Internal Medicine, Sumitomo Hospital, **Department of Nuclear Medicine, Sumitomo Hospital
JournalThe Japanese Journal of nuclear medicine
Volume29
Number4
Page435-442
Year/Month1992/4
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]For the evaluation of myocardial perfusion in patients with left bundle branch block (LBBB), we performed exercise stress (Ex)-redistribution (RD) myocardial tomography with thallium-201(201Tl) in 23 patients with LBBB and without coronary artery disease (CAD). Myocardial images in patients with LBBB were compared with those of 9 patients with CAD who showed Ex induced transient septal defect. Bull'-eye maps (201Tl distribution maps at Ex and RD and 201Tl washout rate [WOR] map) were made from myocardial tomograms. In 23 patients with LBBB, 15 patients (65%) developed myocardial perfusion abnormality. In 10 (67%) of these 15 patients, transient perfusion defect appeared in the entire septum (diffuse type). On the other hand in 5 patients (33%), localized fixed perfusion defect developed at the boundary between septum and anterior wall (focal type). In focal type, every patient had other disease such as hypertension, aortic stenosis or sick sinus syndrome. While in patients with diffuse type, other diseases were observed in 30% (p<0.05) and they were limited to hypertension or diabetes mellitus. These facts suggested that mechanisms of perfusion abnormalities might be different between these two groups. We compared the perfusion abnormality between LBBB diffuse type and CAD. The extent of the defects was not different between two groups. Although apex was included within the defect in 89% of CAD population, apical defect was observed in only 20% of diffuse type (p<0.05). Minimal 201Tl WOR and 201Tl uptake ratio of septum to lateral wall indicated that exercise induced septal defect was slighter in diffuse type than CAD. These points might be useful to differentiate whether CAD participates in the septal defect or not in patients with LBBB.
PracticeClinical medicine
KeywordsLeft bundle branch block, Septal defect, Myocardial tomography with 201Tl, Coronary artery disease.

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