[Indications for PTCA for the infarcted myocardium without redistribution by T1-201 myocardial scintigraphy: the role of two-dimensional echocardiography].
Persistent myocardial hypoperfusion in delayed images demonstrated by preoperative exercise T1-201 myocardial scintigraphy may improve after PTCA. The purpose of this study was to test whether PTCA-induced improvement could be anticipated by means of preoperative two-dimensional echocardiography and exercise T1-201 myocardial scintigraphy. The subjects consisted of 24 patients with prior myocardial infarction, in whom serial exercise T1-201 myocardial scintigraphy had been performed during treadmill exercise testing. The patients were divided into three groups according to the results of two-dimensional echocardiography (Group I: eight patients with hypokinesis in the infarct zone; Group II: eight patients with akinesis without a thin wall in the infarct zone; Group III: eight patients with akinesis with a thin wall in the infarct zone). Results were as follows: 1. There was no significant difference in initial T1-uptake in all the 24 patients before and after PTCA, though significantly increased uptakes were observed in Groups I and II after PTCA. 2. There were significant differences in preoperative initial T1-uptakes among the three groups. 3. In Group II, the patients with postoperative scintigraphic improvement had significantly higher preoperative initial T1-uptakes. 4. The postoperative improvement of myocardial perfusion was accompanied by improvement in wall motion. Therefore, an infarct zone without delayed redistribution in T1-201 myocardial scintigraphy does not necessarily indicate scar tissue. However, it may represent hypokinetic or akinetic areas without thin walls on two-dimensional echocardiograms, suggesting a hibernating myocardial state due to chronic intermittent episodes of myocardial ischemia. In such cases, improvement of myocardial perfusion after PTCA can be expected.
Kubo
H
H
Third Department of Internal Medicine, Toho University School of Medicine, Tokyo.
Yano
K
K
Hasegawa
N
N
Suzuki
M
M
Degawa
T
T
Hirai
H
H
Yabuki
S
S
Machii
K
K
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes