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Nuklearmedizin 1992; 31(06): 213-219
DOI: 10.1055/s-0038-1629626
Originalarbeiten
Schattauer GmbH

Aussagemöglichkeiten der frühen Belastungsmyokardszintigraphie nach PTCA

Relevance of Early Exercise Myocardial Scintigraphy following PTCA
T. Krause
1   Aus der Abteilung Nuklearmedizin (Ärztlicher Dir.: Prof. Dr. Dr. E. Moser), der Radiologischen Universitätsklinik und der Abteilung Kardiologie (Ärztlicher Dir.: Prof. Dr. H. Just) der
,
T. Dornacher
1   Aus der Abteilung Nuklearmedizin (Ärztlicher Dir.: Prof. Dr. Dr. E. Moser), der Radiologischen Universitätsklinik und der Abteilung Kardiologie (Ärztlicher Dir.: Prof. Dr. H. Just) der
,
T. Bonzel
2   Medizinischen Universitätsklinik des Klinikums der Albert-Ludwigs-Universität Freiburg/Br., FRG
,
H. Wollschläger
2   Medizinischen Universitätsklinik des Klinikums der Albert-Ludwigs-Universität Freiburg/Br., FRG
,
C. Schümichen
1   Aus der Abteilung Nuklearmedizin (Ärztlicher Dir.: Prof. Dr. Dr. E. Moser), der Radiologischen Universitätsklinik und der Abteilung Kardiologie (Ärztlicher Dir.: Prof. Dr. H. Just) der
,
E. Moser
1   Aus der Abteilung Nuklearmedizin (Ärztlicher Dir.: Prof. Dr. Dr. E. Moser), der Radiologischen Universitätsklinik und der Abteilung Kardiologie (Ärztlicher Dir.: Prof. Dr. H. Just) der
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Publikationsverlauf

Eingegangen: 12. März 1992

Publikationsdatum:
04. Februar 2018 (online)

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Zusammenfassung

Bei 69 Patienten mit Koronarstenosen >60% wurde vor und nach primär erfolgreicher PTCA eine szintigraphische Kontrolle durchgeführt. Angiographisch fand sich eine Reduktion des mittleren Stenosegrads von 74 ± 10% auf 31 ± 11% (58% Abnahme). Die tomographische Belastungsmyokardszintigraphie mit 201TI zeigte bei der Frühkontrolle innerhalb von 3 Wochen nach PTCA eine Verkleinerung des Perfusionsdefektes von 17,0 ± 14,6 auf 5,8 ± 7,8 relative Einheiten (66% Abnahme). Nach 6 Monaten wurde angiographisch bei 22/41 Patienten (54%) eine Re-Stenosierung nachgewiesen. Die szintigraphische Frühkontrolle erlaubte hierzu keine prognostische Aussage (positiver und negativer Vorhersagewert bei Eingefäßerkrankungen: 61% bzw. 41%). Eine szintigraphische Kontrolle des Dilatationserfolgs ist dagegen möglich (Sensitivität 83%), wenn auch unmittelbar nach dem Eingriff reversible Speicherdefekte als Hinweis auf Ischämie noch häufig auftreten (alle Patienten: 43/69; Patienten mit Eingefäßerkrankung: 31/55) und nicht gleichbedeutend mit einem Mißerfolg sind. Wegen dieser residualen Perfusionsstörungen unmittelbar nach PTCA ist ein Vergleich mit dem Befund vor Dilatation Voraussetzung für eine sichere Erfolgskontrolle.

Summary

Exercise 201TI scintigraphy before and after successful PTCA was evaluated in 69 patients with coronary stenosis >60%. Mean luminal stenosis was found reduced from 74 ± 10% to 31 ± 11% (58% reduction). Scintitomographic examination within 3 weeks following intervention showed a reduction of the exercise perfusion defect from 17.00 ± 14.6 to 5.8 ± 7.8 arbitrary units (66% reduction). Angiographically, re-stenosis was identified in 22/41 patients (54%) after 6 months. Unexpectedly, re-stenosis could not be predicted by early 201TI scintigraphy (positive and negative predictive value in patients with singlevessel disease: 61% and 41%, resp.). Nevertheless, evaluation of PTCA results was possible (sensitivity 83%). However, postinterventional transient defects, indicating ischemia, were often seen (all patients: 43/69; patients with single-vessel disease: 31/55) and not indicative of failure of the intervention. Thus, post-PTCA scintigrams should be compared with scintigrams recorded before the intervention to ensure reliable follow-up control.

Schlüsselwörter

Koronare Herzkrankheit - PTCA - 201Thallium

Key words

Coronary heart disease - thallium-201 - PTCA
 

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