高血压伴或不伴左室肥厚病人运动^(201)TI心肌灌注显像异常分类及其机制

Different patterns of abnormalities in exercise ^(201)Tl myocardial scintigraphy and their mechanisms

目的探讨高血压伴或不伴左室肥厚病人运动铊-201(201TI)心肌灌注显像异常分类及其可能机制。方法254例可疑冠状动脉疾病病人接受了201TI运动-延迟心肌灌注断层显像。其中无高血压组84例,高血压无心肌肥厚组93例,高血压伴心肌肥厚组77例。所有灌注异常者均在显像前或后1个月内行冠脉造影。将灌注异常者分为3类:节段型、非节段型和混合型。对上述病人灌注显像异常而冠状动脉造影正常者进行长期随访。结果在高血压无心肌肥厚和伴心肌肥厚病人中,节段型异常的发生率分别为52/60和32/58,非节段型异常率分别为4/60和9/58,混合型异常率分别为4/60和17/58。节段型异常的冠脉造影正常率为17/84,非节段型异常为13/13,混合型异常为10/21。对40例灌注异常且冠脉造影正常的病人进行随访,5例节段型和2例混合型异常出现与大冠状动脉病变有关,且病变部位相符;而非节段型异常无1例发生。结论高血压伴或不伴心肌肥厚病人的节段型异常可能不仅由冠脉大动脉的解剖狭窄引起,而且还可能由冠状大动脉的功能性狭窄引起。非节段型异常则可能只由肌内微血管病变引起。

Objective To categorize the patterns of abnormalities in exercise ^201TI myocardial scintigraphy and explore the mechanisms. Methods Exercise ^201TI myocardial scintigraphy was performed in 203 patients with clinically suspected coronary artery disease, including 74 normotensive patients, 78 hypertensive patients without left ventricle hypertrophy （LVH） and 51 hypertensive patients with LVH. All the patients underwent coronary angiography one month before or after ^201TI myocardial scintigraphy, and the patterns of abnormal findings were categorized as segmental, non-segmental and mixed patterns. Patients with abnormal ^201TI myocardial perfusion and normal coronary angiographic findings were followed up. Results In hypertensive patients without and with LVH, the ratios of abnormal perfusion in segmental, non-segmental and mixed types were 52/60 and 32/58, 4/60 and 9/58, and 4/60 and 17/58, respectively. The ratios of normal coronary angiography in the 3 types were 17/84, 13/13 and 10/21, respectively. Among the 40 patients followed up, 5 with segmental abnormality and 2 with mixed abnormalities developed large coronay artery disease, which was found in none of the patients with segmental abnormality. Conclusions In hypertensive patients with and without LVH, segmental perfusion abnormalities may be attributed to the anatomic and functional stenosis of the large coronary arteries, and the non-segmental abnormal perfusion might be only possible with coronary microvascular diseases.