ASSESSMENT OF QUANTITATIVE EXERCISE THALLIUM-201 EMISSION COMPUTED TOMOGRAPHY IN PATIENTS WITH VASOSPASTIC ANGINA : Value of Washout Rate Analysis
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概要
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This study was performed to assess the value of washout rate analysis of quantitative exercise thallium-201 emission computed tomography in vasospastic angina patients without significant coronary stenosis. Quantitative analysis of both thallium-201 perfusion and washout rate before and after drug treatment was performed in 48 patients with vasospastic angina and no significant coronary artery stenosis. All of the patients attained more than 90% of their agepredicted heart rate during each exercise test. Before drug treatment, 26 patients exhibited exercise-induced ischemia (perfusion defects on stress polar map), 17 did not exhibit exercise-induced ischemia (normal stress and washout rate polar maps), and the remaining 5 patients showed no perfusion defects, but did show extensive abnormal washout rates. On coronary angiography, multivessel coronary spasm was documented in 12 of the 26 patients with exercise-induced ischemia, in 7 of the 17 patients without exercise-induced ischemia and in 4 patients with an extensive abnormal washout rate and a normal stress polar map. In the 17 patients without exercise-induced ischemia, the mean washout rate was significantly decreased (p<0.05) in association with a significant decrease in the double product (p<0.05) after drug treatment. Of the 26 patients with exercise-induced ischemia, 18 (group 1) showed an increase in the mean washout rate with improved perfusion defect after drug treatment. The remaining 8 patients (group 2) showed a decrease in the mean washout rate with improved perfusion defect after drug treatment, which increased significantly on repeat exercise test performed after additional increased doses of antianginal drugs were administered (p<0.01). The number of patients with multivessel coronary spasm was significantly high in group 2 (p<0.01). Thirteen patients showed an extensive abnormal washout rate before drug treatment, including 8 patients with exercise-induced ischemia and 5 patients with no perfusion defects, who showed an increased mean washout rate after drug treatment (p<0.05). These findings indicate that washout rate analysis aids in the diagnosis in vasospastic angina patients with exercise-induced ischemia. Some patients with exercise-induced ischemia can not be detected by thallium-201 perfusion analysis alone, especially those with multivessel coronary spasm and when this procedure is performed after drug treatment. In addition, a high frequency of abnormal washout rate in vasospastic angina may result not only from exercise-induced ischemia due to main epicardial coronary artery spasm, but also from microspasm, or impariment of microcirculation or myocyte.
- 社団法人日本循環器学会の論文
- 1994-05-20
著者
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YOSHIDA Hiroshi
Department of Clinical Laboratory Medicine, Fukushima Medical College
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Ono Norihisa
Department Of Cardiology Shizuoka General Hospital
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Sakata Kazuyuki
Department Of Cardiology Shizuoka General Hospital Shizuoka
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Sakata Kazuyuki
Department Of Cardiology Shizuoka General Hospital
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Hoshino Tsuneo
Department of cardiology, Tenri Hospital
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Hoshino Tsuneo
Department Of Cardiology Shizuoka General Hospital
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Kaburagi Tsuneo
Department of Cardiology, Shizuoka General Hospital
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MORISHIMA Shigeru
Department of Cell Physiology, National Institute for Physiological Sciences
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Sugino Hiroshi
Department of Cardiology, Shobara Red Cross Hospital
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Sugino Hiroshi
Department Of Cardiology Shizuoka General Hospital Shizuoka
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Kaburagi Tsuneo
Department Of Cardiology Shizuoka General Hospital
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Matsunaga Youichi
Department of Internal Medicine, National Sanatorium Kawatana Hospital
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Yoshida Hiroshi
Department Of Biophysics Graduate School Of Science Kyoto University
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IIMURO MASARU
Department of Cardiology, Shizuoka General Hospital
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Matsunaga Youichi
Department Of Cardiology Shizuoka General Hospital
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Morishima Shigeru
Department Of Cardiology Shizuoka General Hospital
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Iimuro Masaru
Department Of Cardiology Shizuoka General Hospital
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Yoshida Hiroshi
Department Of Nuclear Medicine Shizuoka General Hospital
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Kaburagi Tsuneo
Department Of Cardiology And Nephrology Shizuoka Central Prefectural Hospital
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Yoshida Hiroshi
Departmen Of Radiology School Of Medicine Asahikawa Medical University
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