Japanese
TitleDDDペースメーカー植え込み症例における左室機能および局所心筋灌流に関する核医学的検討
Subtitle原著
Authors若倉学*
Authors(kana)
Organization*東邦大学医学部内科学第一講座
Journal核医学
Volume29
Number5
Page561-572
Year/Month1992/5
Article原著
Publisher日本核医学会
Abstract「要旨」DDDペースメーカー植え込みを行った12例に99mTc標識赤血球による心プールシンチグラフィーと安静時201Tl心筋SPECTを施行し, 右心室ペーシング時における左室機能と局所心筋灌流異常の機序を検討した. 左室駆出率(LVEF)は正常群, ペーシング群間に有意差を認めず, ペーシング群では心房心室順次ペーシング(AVSP), 心室ペーシング(VP)両モード間でも有意差を認めなかった. 一方左室拡張早期最大充満速度(EDPFR)は正常群2.37±0.48(counts/second/EDC), AVSP 0.90±0.52, VP 1.55±0.52と正常群に比しペーシング群で有意に低値を示し(p<0.01), ペーシング群ではVPに比しAVSPで有意に低値を示した(p<0.01). 機能画像では, AVSP時12例中7例, VP時12例中3例に心室中隔から心尖部にかけてのペーシング部位に近接した局所で駆出時間(ET)の延長を認め, 両モードとも12例全例に同様の局所でEDPFRの低下を認めた. 201Tl心筋SPECTでは, AVSP時10例中8例, VP時9例中6例においてペーシング部位に近接した局所で心筋灌流異常を認めた. 以上よりペーシング部位周辺の局所心筋灌流障害の原因として, 同部位の拡張早期充満速度の低下および駆出時間の延長が考えられた.
Practice臨床医学：一般
KeywordsDDD pacemaker, Multigated blood pool study, 201Tl myocardial SPECT.
English
TitleRadionuclide Study of Left Ventricular Function and Regional Myocardial Perfusion in Patients with a DDD Pacemaker
SubtitleOriginal Articles
AuthorsManabu WAKAKURA
Authors(kana)
OrganizationFirst Department of Internal Medicine, Toho University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume29
Number5
Page561-572
Year/Month1992/5
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]In order to determine the influence of right ventricular artificial pacing on left ventricular function, particularly on diastolic specificity and regional myocardial perfusion, 99mTc multigated blood pool study and 201Tl myocardial SPECT at rest were performed on 12 patients with a DDD pacemaker implanted due to atrio-ventricular block at various degrees and on 7 normal adults without pacemaker as controls. Studies were performed on the pacing group during both ventricular pacing (VP) and atrio-ventricular sequential pacing (AVSP) at a rate of 80 beats/min. Although global left ventricular ejection fraction (LVEF) showed no significant differences between the control group (63.7+-9.1%) and the pacing group, or between during AVSP (57.8+-9.6%) and during VP (55.8+-10.0%), global early diastolic peak filling rate (EDPFR) in the pacing group were significantly lower during AVSP (0.90+-0.52 counts/second/end-diastolic counts) than during VP (1.55+-0.52) (p<0.01), which were both found to be lower than those seen in control group (2.37+-0.48 (p<0.01). Functional images disclosed regional prolongation of left ventricular ejection time (ET) in septal and apical areas of the left ventricle adjacent to the pacing site in 7 of the 12 patients (58.3%) during AVSP and in 3 of them (25%) during VP, and also revealed regional decrease in EDPFR in the similar areas in all of the patients during both modes, being more remarkable during AVSP than during VP. On 201Tl myocardial SPECT at rest, regional perfusion impairment was observed in septum, apex and the infero-posterior wall on the septal side adjacent to the pacing site in 8 of 10 patients (80%) during AVSP and in 6 of 9 patients (66.7%) during VP. These results suggest that a change in electrical conduction by right ventricular pacing may disturb regional myocardial relaxation, probably resulting in a regional impairment of myocardial perfusion.
PracticeClinical medicine
KeywordsDDD pacemaker, Multigated blood pool study, 201Tl myocardial SPECT.

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