| Japanese |
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| Title | 洞不全症候群における心筋灌流と心臓交感神経障害 - 冠循環動態と201TlCl/123I-MIBG心筋シンチグラフィの特徴 - |
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| Subtitle | 原著 |
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| Authors | 松村憲太郎*, 中瀬恵美子*, 斎藤孝行**, 橘川信忠**, 灰山徹** |
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| Organization | *京都南病院内科, **放射線科 |
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| Journal | 核医学 |
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| Volume | 31 |
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| Number | 11 |
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| Page | 1321-1328 |
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| Year/Month | 1994/11 |
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| Article | 原著 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」洞不全症候群において左冠動脈DSAで冠循環動態を, 201TlCl心筋SPECTで心筋灌流を, また123I-MIBG心筋SPECTで心臓交感神経障害を評価した. 洞不全症候群69例中43例 (62%) に胸痛の既往があり, この43例中12例 (28%) に心電図変化を伴う典型的な冠攣縮性狭心症の合併が見られた. 冠動脈DSAが得られた41例で冠末梢血管抵抗の増加を反映して左冠循環時間が延長していた. 運動負荷201Tl心筋SPECTで69例中42例 (61%) に灌流欠損が見られ, 冠スパスムによる心筋虚血以外に冠微小循環障害による灌流欠損が考えられた. 201TlCl/123I-MIBG 2核種同時心筋SPECTで13例中11例 (85%) に123I-MIBGの欠損が見られ, また201Tl-SPECTで灌流欠損のない8例中6例で123I-MIBG-SPECTの欠損を認め集積のmismatchを示した. 洞不全症候群では123I-MIBG心筋SPECTで高頻度に欠損像を認め, 心筋虚血の頻度以上に心筋心臓交感神経障害があり, 細冠動脈領域のβ受容体の減少による冠末梢血管抵抗の増加, 微小循環障害などが推測される. |
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| Practice | 臨床医学：一般 |
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| Keywords | Sick sinus syndrome, Coronary circulation, Vasospastic angina, 201TlCl, 123I-MIBG |
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| English |
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| Title | Assessment of Myocardial Perfusion and Cardiac Sympathetic Nerve Dysfunction in Patients with Sick Sinus Syndrome - Evaluation of Coronary Hemodynamics and 201TlCl/123I-MIBG Myocardial SPECT - |
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| Subtitle | Original Articles |
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| Authors | Kentaro MATSUMURA*, Emiko NAKASE*, Takayuki SAITO**, Nobutada KIKKAWA**, Tohru HAIYAMA** |
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| Authors(kana) | |
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| Organization | *Department of Internal Medicine, **Department of Radiology, Kyoto Minami Hospital |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 31 |
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| Number | 11 |
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| Page | 1321-1328 |
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| Year/Month | 1994/11 |
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| Article | Original article |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | [Summary] To clarify the coronary hemodynamics, myocardial perfusion and cardiac sympathetic nerve function in patients with sick sinus syndrome (SSS), we performed left coronary digital subtraction angiography (DSA) in 41 patients, exercise 201TlCl-myocardial scintigraphy (planar and SPECT) in 69 patients, and 201TlCl/123I-MIBG myocardial dual SPECT in 13 patients without significant organic coronary stenosis. Coronary artery spasm was documented on coronary angiography in 25/43 (58%) patients with SSS by ergonovine provocation test. Compared with normals, patients with SSS demonstrated prolongation of left coronary circulation time (CCT) on own heart beats and right atrial pacing. We suspected that prolonged CCT may be induced by increased peripheral coronary vascular resistance and impaired coronary microcirculation in patients with SSS. Forty-two patients (60.9%) developed exercise-induced 201Tl-myocardial perfusion defect on SPECT images. On myocardial dual SPECT images, 11/13 (85%) patients showed localized myocardial low uptake in 123I-MIBG-SPECT images. In eight patients with normal findings on 201Tl-SPECT, six patients showed abnormality on 123I-MIBG-SPECT. We suspected that coronary vasospasm, impaired coronary micro-circulation and cardiac sympathetic nerve dysfunction are taken a part of pathophysiology in SSS (decreased β-adrenergic receptor of peripheral coronary arteries?). |
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| Practice | Clinical medicine |
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| Keywords | Sick sinus syndrome, Coronary circulation, Vasospastic angina, 201TlCl, 123I-MIBG |
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