- 期刊
Multivessel Coronary Artery Disease Presented With Normal Myocardial Perfusion Scan: The Significance of a High Transient Ischemic Dilation
多支血管冠狀動脈疾病於正常心肌灌注掃描：高短暫性缺血性擴張的重要
摘要
Transient ischemic dilation (TID) is significantly correlated with stress-induced diffuse subendocardial hypoperfusion, and produces a visually larger left ventricular cavity. A high TID ratio is indicative of severe and extensive multi-vessel coronary artery disease (CAD) and high risk of cardiac events, even in acquisitions with normal perfusion. We report a case of a 65-year-old female with a long history of diabetes mellitus, hypertension, and hyperlipidemia, who had a non-ST elevation myocardial infarction in 2009 and underwent stent deployment for right coronary artery (RCA) disease. About 1 month ago, the patient had a sudden onset of dyspnea and retrosternal chest pressure while mopping that persisted for 30 min with a partial response to nitroglycerin. Myocardial perfusion study showed homogeneous distribution of radiotracer (thallium chloride) in stress and rest tests at all myocardial walls. However, a high TID ratio (1.58) was noted. Coronary angiogram revealed 90% proximal left anterior descending artery (LAD) stenosis, proximal RCA 50% in-stent restenosis, middle RCA 70% in-stent restenosis, and distal RCA 70% stenosis. Stenting of the LAD and distal RCA, and balloon dilatation of the RCA in-stent restenosis was performed. In this case with hypertension, diabetes, hyperlipidemia and a previous history of CAD, the TID ratio provides incremental diagnostic value for the identification of severe and extensive CAD.
並列摘要
短暫性缺血性擴張（transient ischemic dilation, TID），與壓力誘導的瀰漫性心內膜下低灌注顯著相關，有視覺上較大的左心室腔。高TID值，表示嚴重及廣泛的多支冠狀動脈疾病，和高風險的心臟發生事件，縱使為正常心肌灌注掃描。我們報告一例65歲女性，長期患有糖尿病、高血壓和高脂血症，2009年患有非ST段抬高心肌梗塞，接受右冠狀動脈的支架置入術。1個月前，患者在拖地時，突然出現呼吸困難和胸骨後胸部壓迫，持續30 min，對硝酸甘油有部分反應。其心肌灌注檢查顯示，放射性示踪劑（TlCl）於所有心肌壁在壓力相和休息相皆均勻分布；然注意到有高的TID值（1.58）。冠狀動脈造影顯示，左前降支近端90%狹窄、右冠狀動脈近端50%支架內再狹窄，右冠狀動脈中段70%支架內再狹窄，右冠狀動脈遠端70%狹窄。於左前降支和右冠狀動脈遠端進行支架置入，以及於右冠狀動脈支架內再狹窄進行氣球擴張。該個案有高血壓、糖尿病、高脂血症和冠狀動脈疾病病史，TID值替嚴重及廣泛的冠狀動脈疾病的鑑識增加了診斷價值。
延伸閱讀
- 黃靜惠（2015）。探索可預測急性心肌梗塞患者接受氣球擴張術後的冠狀動脈再狹窄和左心室重塑之血液標誌因子〔博士論文，國立交通大學〕。華藝線上圖書館。https://doi.org/10.6842/NCTU.2015.00142
- 陳佩儀、林紘毅（2022）。經橈動脈的冠狀動脈導管介入合併腔室症候群及嚴重神經血管併發症：病例報告及文獻回顧。台灣復健醫學雜誌，50(2)，167-172。https://doi.org/10.6315/TJPMR.202212_50(2).0010
- Su, H. M., Voon, W. C., Lin, C. C., Chen, Y. F., Lin, T. H., Lai, W. T., & Sheu, S. H. (2004). 急性心肌梗塞的病人在接受早期成功的血栓溶解治療後發生心室中膈缺損－病例報告. The Kaohsiung Journal of Medical Sciences, 20(5), 235-239. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200405-20-5-235-239-a
- Tsai, B., Ko, J. T., Liu, Y. C., & Lin, M. H. (2009). 再審視冠狀動脈瘻管病人Dipyridamole壓力／重分佈鉈－201心肌灌注造影的表現：四病例報告. 核子醫學雜誌, 22(1), 59-66. https://doi.org/10.6332/ANMS.2201.009
- 劉雅萍、王梓軒、侯貴圓、曾文昌、賴世育、王永成、莫元亨（2009）。利用64列多排偵檢器電腦斷層掃描儀偵測左前降枝冠狀動脈心肌橋及近端血管動脈粥狀硬化的發生率。輔仁醫學期刊，7(3)，103-111。https://www.airitilibrary.com/Article/Detail?DocID=18102093-200912-201004090004-201004090004-103-111