Japanese
Title経皮的冠血行再建術 (PTCA) にともなう早期心筋脂肪酸代謝障害 - その臨床的意義と回復過程 -
Subtitle原著
Authors桑原洋一*, 藤井清孝*, 唐木章夫*, 山崎行雄*, 伏島堅二*, 斉藤俊弘*, 増田善昭*
Authors(kana)
Organization*千葉大学医学部第三内科
Journal核医学
Volume33
Number1
Page9-17
Year/Month1996/1
Article原著
Publisher日本核医学会
Abstract「要旨」PTCA後に認める脂肪酸代謝障害を心筋侵襲の面から評価し, その臨床的意義を検討した. 待機的PTCA症例で再狭窄や重大な合併症を認めなかった23例に対し, BMIPPシンチ(BM)を(1)PTCA前, (2)直後(72時間後), (3)3か月後に撮像し, 心筋を7分画に分け半定量的に評価し, PTCA後にみられる心筋脂肪酸代謝障害を, 同時期に施行した負荷タリウムシンチ(Tl)上の血流の変化, PTCA時の虚血所見, 左室造影による壁運動の変化との関連を検討した. 全例に負荷Tl上血流の改善が認められたが, PTCA直後にBMの集積低下が14例(61%)に認められ, 不変2例, 増加7例であった. PTCA対象となった91分画について検討すると, 30分画(33%)が集積低下, 48分画が不変, 改善が見られたのはわずか13分画であった. PTCA直後のBM集積低下に関わる因子は, バルーニングによる冠閉塞時間(p<0.05), 胸痛(p=0.08), ST上昇(p=0.01), 当該区域への側副血行欠損(p<0.01), 罹患枝数(p=0.01)であり, 径の小さいバルーンで短時間行うpre-dilatation(p=0.01)はBM集積低下を予防した. 多変量解析(logistic regression)では, PTCA時胸痛, 閉塞時間, pre-dilatationが独立して有意にBM集積低下に関連した. PTCA 3か月後の所見では, 直後にBM集積低下を認めた分画は左室造影上の壁運動改善が不良であったが(P<0.05), Tl上の血流はBMIPP集積低下を認めた領域と同様の動きを示した. PTCA後早期におけるBMIPP集積低下はPTCA時の虚血所見と関連し, 血行再建後の脂肪酸代謝障害の持続, 壁運動の改善不良という形でのstunned myocardiumを示唆する所見と考えられた. したがって, PTCA手技そのものの良否, 術後の管理, 予後判定, 使用する薬剤評価に有用である可能性が示された.
Practice臨床医学：一般
Keywords123I-BMIPP myocardial SPECT imaging, Stunned myocardium, Percutaneous transluminal coronary angioplasty.
English
TitleFatty Acid Metabolic Disorder Detected by 123I-BMIPP SPECT Shortly after Elective Percutaneous Transluminal Coronary Angioplasty
Subtitle
AuthorsYoichi KUWABARA, Kiyotaka FUJII, Akio KARAKI, Yukio YAMAZAKI, Kenji FUSEJIMA, Toshihiro SAITO, Yoshiaki MASUDA
Authors(kana)
OrganizationThird Department of Internal Medicine, Chiba University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume33
Number1
Page9-17
Year/Month1996/1
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] Decreased or unchanged BMIPP uptake is often observed in the repeated SPECT imaging soon after successful angioplasty, although coronary flow remarkably recovers. To evaluate clinical significance of this phenomenon, 23 patients underwent BMIPP SPECT before elective PTCA(BM-1), soon after PTCA(72 hours, BM-2), and 3 months later(BM-3). SPECT imagings were divided into 7 segments and were semiquantitatively evaluated by 2 cardiologists in the blinded fashion. Decreased uptake at BM-2 compared with BM-1 was evaluated by comparing with stress Thallium-201 SPECT performed in the same schedule but on the different date(Tl-1, 2, 3), ischemic manifestation at PTCA, and wall motion change of LVG. Patients with restenosis were excluded from this study. RESULTS : BM-2 showed decreased uptake in 14(61%), unchanged in 2(9%), and increased in 7(30%) patients, while stress Tl showed increased perfusion in all patients. Among 91 myocardial segments correspondent to PTCA vessels, 30(33%) showed overt uptake reduction, and only 13(14%) segments showed increased uptake. BM-2 uptake reduction was significantly associated with the absence of collateral artery (odds ratio, OR=3.1, p<0.01), multi vessel disease (OR=2.0, p=0.01), total balloon inflating time(p<0.05), ST elevation on ECG (OR=3.6, p=0.01), chest pain during PTCA (OR=3.1, p<0.1), while pre-dilatation by using small size balloon catheter prevented BM-2 uptake reduction (OR=6.0, p=0.01). Multiple logistic regression analysis showed that chest pain, balloon inflating time and pre-dilatation were independently associated with BM-2 uptake reduction. Three months after PTCA, the segments with BM-2 reduction had stress Tl uptake similar to the segments without BM-2 reduction, however, they showed poorer recovery of BM-3 uptake and LV wall motion. CONCLUSION ; BMIPP uptake reduction shortly after angioplasty was associated with ischemic manifestation and poor LV motion recovery, thus, it may be a sensitive representation of the stunned myocardium.
PracticeClinical medicine
Keywords123I-BMIPP myocardial SPECT imaging, Stunned myocardium, Percutaneous transluminal coronary angioplasty.

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