[Assessment of microcirculation disturbance with nuclear cardiology in a patient with coronary ectasia: a case report].
A 69-year-old woman presented with dyspnea on exertion. Echocardiography showed dilatation and diffuse hypokinesis of the left ventricle. 99mTc-tetrofosmin myocardial SPECT showed moderately reduced uptake in the anteroseptal wall and the inferior wall on the rest images, but was improved on the ATP loading images. 123I-BMIPP myocardial SPECT showed severely reduced uptake in the anterior wall and the inferior wall. These SPECT findings suggested ischemic heart disease rather than dilated cardiomyopathy. Coronary angiography showed no organic stenosis, but diffuse coronary ectasia was noted in three vessels. Intravascular ultrasound revealed remarkable coronary ectasia, with a maximal diameter of 8.2 mm. Coronary flow velocity as measured by Doppler blood flow guide wire was remarkably reduced. Coronary spasms were not provocated by ergonovine loading test. These findings suggested that microvascular thrombi and disturbance of dilatation caused myocardial ischemia in this patient. We treated the patient with ticlopidine and nicorandil. Following treatment left ventricle wall motion, 99mTc-tetrofosmin and 123I-BMIPP myocardial SPECT findings were improved.
Nishikawa
Susumu
S
Department of Cardiology, Murakami Memorial Hospital, Asahi University.
Ito
Kazuki
K
Takata
Hiroki
H
Tsubakimoto
Yoshinori
Y
Yuba
Tatsuya
T
Adachi
Yoshihiko
Y
Kato
Shuji
S
Azuma
Akihiro
A
Sugihara
Hiroki
H
Nakagawa
Masao
M
D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology*; D004108:Dilatation, Pathologic; D005227:Fatty Acids; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008833:Microcirculation / Q000000981:diagnostic imaging / Q000473:pathology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C049338:iodofiltic acid; C078700:technetium tc-99m tetrofosmin