Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

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概要

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• Background Exercise gated single-photon emission computed tomography (SPECT) using technetium-99m (^<99m>Tc)-sestamibi evaluates both myocardial perfusion during stress and wall motion >30min after the stress, which has the potential to assess not only exercise-induced myocardial ischemia but also the development of myocardial stunning. Methods and Results To evaluate the incidence of post-stress myocardial stunning, as well as comparing the effects of different stress methods on the development of stunning, 179 consecutive patients with known or suspected coronary artery disease (CAD) underwent ^<99m>Tc-sestamibi SPECT with either exercise (n=135) or adenosine triphosphate disodium (ATP) (n=44). Electrocardiogram-gated SPECT images were acquired >30min after the stress and again 4h later, and perfusion and wall motion were evaluated. Post-stress myocardial stunning occurred in 24 patients (13%) : 22 after exercise and 2 after ATP stress. The magnitude of the transient wall motion abnormality after exercise was greater in patients with severe ischemia, compared with those with mild-to-moderate ischemia (p<0.0001). By contrast, with ATP stress, the magnitude of the transient wall motion abnormality was similar, regardless of the severity of perfusion abnormality. Furthermore, a significant correlation between summed difference score and transient wall motion abnormality was found after exercise (r=0.68, p<0.0001). With ATP, however, no such correlation was observed (r=0.28, p=NS). Conclusions Using ^<99m>Tc-sestamibi gated SPECT, myocardial stunning is frequently observed after exercise and correlates with the severity of myocardial ischemia, but this does not occur with ATP, which is regarded as a specific marker for severe CAD.

• 2005-10-20

著者

• USUI Yasuhiro

  Department of Cardiology, Tokyo Medical University

• Yamashina Akira

  武蔵野赤十字病院

• Hida S

  Department Of Cardiology Tokyo Medical University

• Ikarashi Yuuko

  Department Of Cardiology Tokyo Medical University

• Harafuji Katsufumi

  Second Department of Internal Medicine, Tokyo medical University

• Harafuji Katsufumi

  Departments of Internal Medicine II

• Chikamori Taishiro

  Department Of Cardiology Tokyo Medical University

• Tanaka Hirokazu

  Department Of Cardiology Tokyo Medical University

• Harafuji Katsufumi

  Second Department Of Internal Medicine Tokyo Medical University

• Hida Satoshi

  Department Of Cardiology Tokyo Medical University

• Yamashina Akira

  Department Of Cardiology Tokyo Medical University

• Chikamori Taishiro

  Cardiology, Tokyo Medical University

• Usui Yasuhiro

  Cardiology, Tokyo Medical University

• Igarashi Yuko

  Cardiology, Tokyo Medical University

• Harafuji Katsufumi

  Second Department Of Internal Medicin Tokyo Medical University

• Tanaka Hirokazu

  Department Of Applied Physics National Defense Academy

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