Usefulness of 201TlCl/123I-BMIPP dual-myocardial SPECT for patients with non-ST segment elevation myocardial infarction

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• 作者：Yoshimitsu Fukushima (1)
  Masahiro Toba (1)
  Keiichi Ishihara (1)
  Sunao Mizumura (1)
  Tomohiko Seino (2)
  Keiji Tanaka (2)
  Kyoichi Mizuno (2)
  Shin-ichiro Kumita (1)
  
• 关键词：Non ; ST segment elevation myocardial infarction ; Cardiac troponin T ; 123I ; BMIPP myocardial SPECT
• 刊名：Annals of Nuclear Medicine
• 出版年：2008
• 出版时间：June 2008
• 年：2008
• 卷：22
• 期：5
• 页码：363-369
• 全文大小：302KB
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• 作者单位：Yoshimitsu Fukushima (1)
  Masahiro Toba (1)
  Keiichi Ishihara (1)
  Sunao Mizumura (1)
  Tomohiko Seino (2)
  Keiji Tanaka (2)
  Kyoichi Mizuno (2)
  Shin-ichiro Kumita (1)
  
  1. Department of Clinical Radiology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
  2. Department of Functional Pathophysiology for Human Organs, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
  

文摘

Objective Earlier studies suggested that elevated cardiac troponin T (cTnT) might be useful for detecting less severe types of myocardial injury (i.e., non-ST segment elevation myocardial infarction). The objective of this study is to elucidate the usefulness of 201thallous chloride (201TlCl) and 123I-betamethyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) dual-single-photon emission computed tomography (SPECT) imaging for patients with myocardial infarction (MI) without ST segment elevation. Methods Consecutive 86 patients (56 men and 30 women; mean age 66 ± 12 years) clinically diagnosed with acute myocardial infarction (AMI) were divided into two groups according to serum creatine kinase MB (CK-MB) and cTnT levels. Group A consisted of 53 patients with increased serum CK-MB and cTnT levels, and Group B, 33 patients with increased serum cTnT without increased serum CK-MB. All patients underwent 201TlCl and 123I-BMIPP dual-SPECT about 8 days following the onset. The left ventricular myocardium was divided into 20 segments on each SPECT image, and tracer accumulation in those segments was scored on a five-point scoring system. The total defect scores (TDS) were calculated by summing the scores for all 20 segments, and compared between groups A and B. Group B patients were subdivided into two groups according to the TDS on 123I-BMIPP images as groups BS (severe; TDS ?8) and BM (mild; TDS ?7), and we compared the prognosis over a period of 2 years from the onset between the three groups. Results The TDS of group A derived from 201TlCl and 123I-BMIPP images was significantly higher than those of group B (14.5 ± 10.8 vs. 1.5 ± 2.4 and 20.8 ± 13.3 vs. 9.1 ± 6.2, respectively; P < 0.0001). The sensitivities of 201TlCl and 123I-BMIPP images were 94.3% (50/53) and 96.2% (51/53) to detect the culprit coronary lesions in group A (no significant difference). In contrast, the sensitivity of 123I-BMIPP images (72.7%, 24/33) was higher than that of 201TlCl images (27.3%, 9/33) in group B (P < 0.05). At 2 years of follow-up, the incidence of hard cardiac events in groups A, BS, and BM was 24.5%, 27.8%, and 6.7%, respectively. The rate of group BS, as well as that of group A, was significantly higher than that of group BM (P < 0.05). Conclusions Of those with a clinical diagnosis of AMI accompanied by increased cTnT, the CK-MB negative patients accounted for 38% (33/86) of all patients as having non-ST segment elevation myocardial infarction such as NTMI. For such patients, 123I-BMIPP imaging is useful not only for the detection of the culprit lesions but also for the prediction of the prognosis.