Vitalitätsdiagnostik mit der ²⁰¹T1-SPECT in Ruhe zur Vorhersage der Reversibilität linksventrikulärer Wandbewegungsstörungen

Zusammenfassung

Ziel: Die Studie überprüft die Eignung der Ruhe-SPECT mit ²⁰¹TI und quantitativer Auswertung zur Vitalitätsdiagnostik anhand der präoperativen Vorhersage der Reversibilität von linksventrikulären Wandbewegungsstörungen. Methodik: Eingeschlossen wurden 19 Patienten mit angiographisch gesicherter koronarer Herzkrankheit und regionalen Wandbewegungsstörungen, die präoperativ einer ²⁰¹TI-SPECT (Acquisition 15 min und 3 h p. i.) unterzogen, erfolgreich revaskularisiert und drei Monate nach Revaskularisation koronarangiographisch und kineventri-kulographisch nachuntersucht wurden. Ergebnisse: Der minimale relative ²⁰¹TI-Uptake in den Aufnahmen 3 h nach Ruheinjektion im Zentrum des Defektes trennte am besten die vor der Revaskularisation aoder dyskinetischen Segmente mit postinterventionell verbesserter (²⁰¹TI-Uptake 67 ± 14%) von solchen ohne Erholung der Wandmotilität (²⁰¹TI-Uptake 46 ± 12%, p<0.001). Durch Wahl des Grenzwertes bei einem Uptake von mindestens 50% ließ sich ein positiver prädiktiver Wert von 0,73 und ein negativer von 0,86 erreichen. Für die Gesamtheit aller Segmente mit Wandbewegungsstörungen (einschließlich Hypokinesien) konnte kein geeigneter Schwellenwert gefunden werden, erst ab einem ²⁰¹TI-Uptake <80% des Maximums zeigten alle betroffenen Segmente postinterventionell eine Besserung (vital) und kein Segment mit einem Uptake <40% besserte sich (avital). Eine Abhängigkeit unserer Ergebnisse von der Lage des Defektes in oder außerhalb der Hinterwand wurde nicht beobachtet. Die ²⁰¹TI-Rückverteilung zwischen den frühen und späten Aufnahmen ließ sich für die Vorhersage der Reversibilität der Wandbewegungsstörungen nicht sicher einsetzen. Schlußfolgerung: Für Segmente mit Hypokinesien existiert eine breite Zone relativer ²⁰¹TI-Uptake-Werte ohne genaue Zuordnung zur Reversibilität der Wandbewegungsstörungen. Die Ruhe-SPECT mit ²⁰¹TI erlaubt eine präinterventionelle Vorhersage über die Erholung der regionalen linksventrikulären Pumpfunktion nur für a- oder dyskinetische Wandabschnitte und ist damit prinzipiell zur Vitalitätsdiagnostik des Myokards geeignet.

Summary

Aim: The aim of the present study was to predict preoperatively the reversibility of left ventricular wall motion abnormalities using Tl-201 SPECT at rest. Methods: 19 patients with advanced coronary artery disease and regional wall motion abnormalities were examined at rest with Tl-201 SPECT (acquisition 15 minutes and 3 hours post injection), successfully revascularized, proven by a second coronary angiography three month after revascularisation. Wall motion was again evaluated by cineventriculography. Results: The preoperative a- or dyskinetic segments were best separated by the minimal relative Tl-201 uptake in the defect 3 hrs p.i. in (i) postinterventionally improved wall motion (Tl-201 uptake 67 ± 14%, viable) and in (ii) without recovery (Tl-201 uptake 46 ± 12%, p<0.001, non viable). A threshold at a Tl-201 uptake of more than 50% yielded a positive predictive value of 0.73 and a negative predictive value of 0.86. If the segments with wall motion abnormalities (hypokinetic included) were evaluated as one group, no such threshold was obtained: all segments which occured a Tl-201 uptake of more than 80% showed a functional recovery, wall motion did not improve in any segment with a Tl-201 uptake of less than 40%. In the present study a considerable influence of the defect localisation with regard to the posterior wall was not observed. The values of Tl-201 redistribution under resting condition were not useful to predict functional recovery. Conclusion: Tl-201 SPECT in rest predicts preoperatively the reversibility in regions with severe wall motion abnormalities only and indicates myocardial viability in these cases. Thus, the method is basicly useful to determine myocardial viability. In hypokinetic segments, however, a wide range of TL-201 uptake values exists without definite evidence to functional recovery.

Schlüsselwörter

SPECT - 201-Thallium - myokardiale Vitalität - koronare Herzerkrankung

Keywords

Emission computed tomography - Thallium-201 - viability - coronary artery disease

• Literatur

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