게이트 심근관류 SPECT상 운동 유발성 기절심근을 보이는 환자의 운동부하 심전도, 관류 SPECT 및 심혈관 조영술 소견 (Characteristic Findings of Exercise ECG Test, Perfusion SPECT and Coronary Angiography in Patients with Exercise Induced Myocardial Stunning) |
Author |
안병철,서지형,배진호,정신영,박헌식1,이재태,채성철1,이규보, |
Byeong-Cheol Ahn, MD., Ji-Hyoung Seo, MD,. Jin Ho Bae, MD., Shin Young Jeong, MD., Hun Sik Park1, MD.,Jaetae Lee, MD., Shung Chull Chae1, MD., and Kyu Bo Lee, MD. |
Affiliation |
경북대학교 의과대학 핵의학교실, 내과학교실1 Departments of Nuclear Medicine and Internal Medicine1, Kyungpook National University Hospital, Kyungpook National Unversity Medical School, Daegu, Korea |
Abstract |
Purpose : Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed
in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical
characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial
perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction.
Materials and Methods : Among subjects who underwent exercise stress test, myocardial perfusion SPECT and
coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction
(LVEF) was ≥5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was
lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was
performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also
performed by conventional Judkins method. Results : Stunning group had a significantly higher incidence of
hypercholesterolemia than non-stunning group(45.5 vs. 7.1%, p=0.01). Stunning group also had higher incidence of
diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group
had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent
18.2 vs. 9.2%, p=0.029; severity 13.5 vs. 6.9, p=0.040). Stunning group also had higher degree of reversibility of
perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis
(80~99%) in coronary angiography than non-stunning group, but these were not statistically significant. In
stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received
revascularization treatment. Conclusion : Patients with post-stress LV dysfunction had larger and more severe
perfusion defect and severe coronary artery stenosis than patients without post-stress LV dysfunction. All of the
patients without perfusion defect in stunning group had significant coronary artery stenosis and needed revas
cularization. Therefore, we suggest that invasive diagnostic procedures and therapeutic interventions might be
needed in patients with post-stress LV dysfunction. (Korean J Nucl Med 38(3):225-232, 2004) |
Keyword |
Post-stress myocardial stunning, Left ventricular ejection fraction, Gated myocardial perfusion SPECT,Angiography, Exercise ECG test. |
Full text Article |
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