以DIPYRIDAMOLE鎝-99m MIBI心肌灌注掃描評估心肌梗塞後胸痛的病人

Dipyridamole Tc-99m MIBI Myocardial Perfusion Scintigraphy in Patients with Post-Infarction Chest Pain Symptom

楊朝欽(Chao-Chin Yang) ； 吳重慶(Chung-Chieng Wu) ； 鍾相彬(Shiang-Bin Jong)

《The Kaohsiung Journal of Medical Sciences》 8卷11期 (1992/11) Pp. 605-617

https://doi.org/10.6452/KJMS.199211.0605

摘要

為了對心肌梗塞後的病人，評估靜脈注射dipyridamole鎝 – 99m MIBI 心肌灌注造影(鎝-99m MIBI) 診斷冠狀動脈疾病的功效，及分析胸痛否為其偵測心肌缺血的一個適當指標。73例病人被分為二組：第I組41例，有明顯心肌梗塞後胸痛症狀，第II組32例，無明顯心肌梗塞後胸痛症狀，其中第一組有19例(第I A組)，第II組有11例(第II A組) 並接受冠狀動脈攝影檢查以為比較。結果，鎝 -99m MIBI診斷冠狀動脈疾病的(一)靈敏度，偵測為(二)心肌梗塞，(三)心肌梗塞合併周圍心肌缺血，(四)心肌梗塞合併離梗塞區域的心肌缺血或壞死(多條血管疾病)的概率，在第I組17例心靈圖為前壁或前中隔壁心肌梗塞的病人分別為100%，41%，59%和41%；在第II組12例心靈圖為前壁或前中隔壁心肌梗塞的病人分別為92%，50%，42%和8%。在第I組21例心靈圖為下壁心肌梗塞的病人分別為100%，43%，57%和62%；在第II組14例心電圖為下壁心肌梗塞的病人分別為100%，86%，14%和29%。此外，鎝 -99m MIBI檢查心電圖為側壁心肌梗塞的病人：第I組1例為多條血管疾病，第II組2例均為側壁心肌梗塞。至於其它第I組有2例，第II組有3例病人心電圖為合併前壁或前中隔壁和下壁心肌梗塞，及第II組有1例病人為合併前壁和側壁心肌梗塞，鎝-99m MIBI均為多條血籲疾病。而在心電圖為前壁或前中隔壁心肌梗塞的第I A 和II A組病人，冠狀動脈攝影顯示左前下降枝為阻塞後再通的概率分別為9/11(82%)和4/5(80%)，而為多條血管疾病的概率分別為6/11(55%)和0/5(0%)。在心電圖為下壁心肌梗塞的第I A 和II A組病人，冠狀動脈攝影顯示右冠狀動脈為阻塞後再通的概率分別為5/7(71%)和1/4(25%)，而為多條血管疾病的概率分別為6/7(86%)和1/4(25%)。結論，鎝-99m MIBI診斷冠狀動脈疾病在第I組的靈敏度為100%，在第II組為97%，全部病人為99%。鎝-99m MIBI在第I組病人比第II組病人不管在梗塞區域或離更塞區域外的心肌區域，均偵測出更多的心肌缺血。因此，胸痛症狀在心肌梗塞後的病人當為一適當的指標以偵測心肌缺血。

並列摘要

To evaluate the efficacy of stress Tc-99m MIBI myocardial perfusion imaging using intravenous dipyridamole in detecting coronary artery disease (CAD) and to determine if chest pain symptom is a proper index for detection of myocardial ischemia in post-infarction patients, we observed 73 cases (65men, 8women, 38-79 years old) between Sept. 1990 and May 1992. All patients were suffered from old myocardial infarction (MI) evidenced by history and ECG and were divided into two groups: group I involving 41 patients with post-infarction chest pain symptom and group II including 32 patients without post-infarction chest pain symptom. Among them, 19 (group IA) of group I and 11 (group IIA) of goup II received coronary arteriography (CAG) for comparison.
Of the 41 group I post-infarction chest pain patients, 17 suffered from old anterior or antero-septal wall (AW) MI, 21 from old inferior wall (IW) MI, 1 from old lateral wall (LW) MI and 2 from combined old AW and IW (AIW) MI by ECG. All 17 patients with AWMI suffered from AW perfusion defect (7 were MI, 10 were MI with ischemia) but 7 of them from multivessel disease (MVD) by Tc-99m MIBI. All 21 patients with IWMI suffered from IW perfusion defect (9 were MI, 12 were MI with ischemia) but 13 of them from MVD by Tc-99m MIBI. Of the patient with LWMI and 2 patients with AIWMI suffered from MVD by Tc-99m MIBI. Of the 32 group II postinfarction patients without chese pain symptom, 12 suffered from old AWMI, 14 from old IWMI, 2 from old LWMI, 3 from AIWMI and 1 from AlWMI by ECG. Of the 12 patients with AWMI, 11 suffered from AW perfvusion defect (6 were MI, 5 were MI with ischemia) but 1 of them from MVD by Tc-99m MIBI. All 14patients with IWMI suffered from IW perfusion defect (12 were MI, 2 were MI with ischemia) but 4 of them from MVD by Tc-99m MIBI. Of the 2 patients with LWMI suffered from LW infarction by Tc-99m MIBI. Of the 3 patients with AIWMI and 1 with ALWMI suffered from MVD by Tc-99m MIBI.
Of the 11 patients in group IA and 5 patients in group IIA with AWMI, CAG revealed the incidence of infarctrelated recanaliization of LAD was 9/11(82%) and 4/5(80%) respectively and the respective incidence of MVD was 6/11(55%) and 0/5 (0%). Of the 7 patient in group IA and 4 patients in group IIA with IWMI, CAG revealed the incidence of infarct-related recanalizaton of RCA was 5/7(71%) and 1/4(25%) respectively and the respective incidence of MVD was 6/7(86%) and 1/4(25%) respectively and the respective incidence of MVD was 6/7 (86%) and 1/4(25%).
In conclusion, the sensitivity of Tc-99m MIBI in detecting CAD in group I was 100% and 97% in group II, while overall sensitivity was 99%. Tc-99m MIBI detected more myocardial ischemia in the infarct zone and at a distance in group I than in group II. Chest pain symptom seems to be a proper index for detection of myocardial ischemia in post-infarction patients.

並列關鍵字

TC-99 m MIBI ； coronary artery disease ； myocardial infartion