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게이트 심근관류 SPECT상 운동 유발성 기절심근을 보이는 환자의 운동부하 심전도, 관류 SPECT 및 심혈관 조영술 소견
안병철 ( Byeong Cheol Ahn ),서지형 ( Ji Hyoung Seo ),배진호 ( Jin Ho Bae ),정신영 ( Shin Young Jeong ),박헌식 ( Hun Sik Park ),이재태 ( Jae Tae Lee ),채성철 ( Shung Chull Chae ),이규보 ( Kyu Bo Lee ) 대한핵의학회 2004 핵의학 분자영상 Vol.38 No.3
목적: 관상동맥질환을 가진 환자에서는 운동부하 후 일시적인 심근기절로 인하여 좌심실의 벽운동이상과 좌심실구혈률 감소가 발생될 수 있다. 본 연구는 운동 후 좌심실기능저하를 보이는 환자와 그렇지 않은 환자의 관상동맥조영술과 운동부하 심근관류 SPECT 소견을 비교분석 하고자 하였다. 대상 및 방법: 운동부하심전도, 관상동맥조영술 및 심근관류 SPECT를 시행한 환자 중 게이트 SPECT로 구한 좌심실구혈률이 운동 후 5%이상 감소된 36명 (기절심근군)과 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
심장 수술후 좌심실 기능 부전에 빠진 환자에서의 좌심실 순환 보조장치 : 1례 보고 Report of a case
임상현,이철주,소동문,류한영,최호,한정선,최유미 아주대학교 1996 아주의학 Vol.1 No.2
Mechanical Ventricular Assist Device(VAD) can be used in various patient groups including end stage heart disease waiting for heart transplantation, postcardiotomy shock, or acutely deteriorating patients. The auteome of the VAD application is poor and the overall survival rate is less than 30%. We had applied intraaortic balloon pump and centrifugal type Left Ventricular Assist Device(LVAD) in a patient who had shown no left ventricular wall motion and shock state after mitral valve replacement due to myocardial stunning. The LVAD was successfully weaned after 16 hours 55 minutes. The patient recovered from postcardiotomy shock without any complications, and was discharged on the 21st. postoperative day.
유선국,장혁재,하성민,장영걸,이병권,홍영택,김병극,박세일 연세대학교의과대학 2024 Yonsei medical journal Vol.65 No.5
Purpose: In a preclinical study using a swine myocardial infarction (MI) model, a delayed enhancement (DE)-multi-detector computed tomography (MDCT) scan was performed using a hybrid system alongside diagnostic invasive coronary angiography(ICA) without the additional use of a contrast agent, and demonstrated an excellent correlation in the infarct area compared with histopathologic specimens. In the present investigation, we evaluated the feasibility and diagnostic accuracy of a myocardial viability assessment by DE-MDCT using a hybrid system comprising ICA and MDCT alongside diagnostic ICA without the additional use of a contrast agent. Materials and Methods: We prospectively enrolled 13 patients (median age: 67 years) with a previous MI (>6 months) scheduled to undergo ICA. All patients underwent cardiac magnetic resonance (CMR) imaging before diagnostic ICA. MDCT viability scans were performed concurrently with diagnostic ICA without the use of additional contrast. The total myocardial scar volume per patient and average transmurality per myocardial segment measured by DE-MDCT were compared with those from DE-CMR. Results: The DE volume measured by MDCT showed an excellent correlation with the volume measured by CMR (r=0.986, p<0.0001). The transmurality per segment by MDCT was well-correlated with CMR (r=0.900, p<0.0001); the diagnostic performance of MDCT in differentiating non-viable from viable myocardium using a 50% transmurality criterion was good with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 87.5%, 99.5%, 87.5%, 99.5%, and 99.1%, respectively. Conclusion: The feasibility of the DE-MDCT viability assessment acquired simultaneously with conventional ICA was proven in patients with chronic MI using DE-CMR as the reference standard.
김선희 ( Sun Hee Kim ),김강 ( Kang Kim ),김승범 ( Seung Bum Kim ),박윤지 ( Yun Ji Park ),문진창 ( Jin Chang Moon ),전소연 ( So Yeon Jeon ),정래영 ( Lae Young Jung ),이식 ( Sik Lee ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.1
Pheochromocytomas are uncommon catecholamine-releasing tumors. The diversity of its clinical presentation confuses and delays the diagnosis, and results in catastrophic outcomes. We describe a case presenting chest tightness that was initially diagnosed as acute myocardial infarction (AMI). A 62-year-old woman visited our emergency department complaining ongoing chest pain for over 9 hours. Electrocardiogram showed ST-segment depression in leads II, III, aVF, and V5-6. Cardiac biomarkers were slightly elevated: troponin I, 0.517 ng/mL; CK-MB, 8.74 ng/mL. Medical treatment for acute coronary syndrome including parenteral heparin and oral beta blocker is performed. Immediately after admission to coronary care unit, she experienced sudden splitting back pain, headache, palpitation, and sweating with blood pressure rising up to 220/130 mmHg and heart rate up to 100 bpm. Three-dimensional aorta computed tomographic angiography (CTA) was taken to exclude aortic dissection. Unexpectedly, aorta CTA revealed a 4.2 cm-sized left adrenal mass without evidence of aortic dissection. This is a case of pheochrocytoma-related myocardial stunning mimicking AMI that might be linked to either a direct toxic effect of catecholamines or coronary spasm. Therefore the possibility of myocardial ischemia or infarction should be recognized in patients with pheochromocytoma.
반복 게이트 심근 Tc - 99m - MIBI SPECT로 확인한 디피리다몰 부하에 의한 일과성 심근기절현상
고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(Jung Key Chung),이동수(Dong Soo Lee),이원우(Won Woo Lee),윤석남(Seok Nam Yoon),이명묵(Myoung Mook Lee) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1
N/A We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest T1-201 SPECT and 2nd day 24 hour delay T1-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease(24) or having chest pain(3). Stress and rest Tc-99m- sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system(0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale(0 to 3 for normal to dyskinesia) in the lst day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments(20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT:i.e. 1-1: 23 segments, 2-2: 29 segments, 3-3: 3 segments. Re-maining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SFECT. Twenty one segments with wall motion abnormality had normal perfusion(rest:15 segments, 24 hour delay: 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality(persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT(transient prolonged stunning). These 6 segments had normal perfusion at rest(n=4) or at 24 hour delay(n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning(P value〈0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to assess rest wall motion.
정량적 게이트 심근관류 스펙트 검사에서 관류결손이 좌심근질량 측정과 부하 후 좌심실 용적 및 구혈률에 미치는 영향
안병철,배선근,이상우,정신영,이재태,이규보 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.6
목적: 심질환의 예후 인자로 알려진 좌심근 질량 및 좌심실 구혈률을 구할 수 있는 게이트 심근관류 스펙트는 관류결손에 의해 영향을 받을 수 있다. 또한 관류결손을 일으키는 심혈관질환은 안정시와 부하후 좌심실 기능에 영향을 줄 수 있다. 본 연구는 심근관류 스펙트상 관류결손을 가진 환자를 대상으로 하여, 첫째 관류 결손의 크기와 가역성 여부에 따른 안정시와 부하 후 게이트 심근관류 스펙트로 구한 좌심근 질량의 차이를 알아 보았으며, 둘째, 관류결손의 가역성 여부에 따른 안정시와 부하 후 게이트 심근관류 스펙트로 얻은 좌심실 용적과 좌심실 구혈률의 상관성 및 차이를 비교해 보았다. 대상 및 방법: 심근관류 스펙트상 관류 결손이 있는 환자 46명을 대상으로 하였다. 대상 환자 가운데 남자가 34명(73.9%)이었고 평균연령은 64±9세였으며, 40명(87.0%)은 가역성 관류결손이었다. 게이트 심근관류 스펙트는 740MBq의 Tc-99m MIBI를 투여한 후 이중헤드 감마카메라(Vertex Plus, ADAC,USA)를 이용하여 영상자료를 얻었다. 좌심근 질량, 이완기말/수축기말 좌심실 용적 및 좌심실 구혈률은 AutoQUANT 프로그램을 이용하여 구하였다. 결과: 안정시와 부하 후 게이트 심근관류 스펙트로 구한 좌심근 질량은 뛰어난 상관성을 나타내었다. 가역적 관류결손 환자보다 고정 관류결손 환자가, 관류 결손의 크기가 20%미만인 환자가 관류 결손크기가 20% 이상은 환자보다 두 값 사이에 더 높은 상관성이 있었다. 고정 관류결손을 가진 환자는 안정시와 부하 후 게이트 심근관류 스펙트에서 얻은 좌심실 이완기말 용적, 좌심실 수축기말 용적, 좌심실 구혈률에 차이가 없었으나, 가영적 관류결손을 가진 환자에서는 안정시와 부하후 게이트 심근관류 스펙트에서 얻은 좌심실 구혈률에 유의한 차이가 있었다. 가역적 관류결손 환자 40명 가운데 10명(25%)에서는 부하후 게이트 심근관류 스펙트에서 구한 좌심실 구혈률이 안정시에 구한 좌심실 구혈률보다 5% 이상 낮았다. 고정관류 결손환자는 가역적 관류 결손환자에 비해 안정시와 부하 후 좌심실 용적과 구혈률에 더 높은 상관성을 나타내었다. 결론: 관류결손은 게이트 심근관류 스펙트를 이용한 좌심근 질량측정에 영향을 미칠 수 있으며, 고정 관류 결손을 가진 환자 보다 가역적 관류 결손을 가진 환자에서 심근부하 후 과심실 구혈률 감소가 더 빈번하게 발생됨을 알 수 있었다. Purpose: The presence of perfusion defect ma influence the left ventricular mass (LVM) measurement by quantitative gated myocardial perfusion SPECT (QGS), and ischemic myocardium, usually showing perfusion defect may produce post-stress LV dysfunction. This study was aimed to evaluated the effects of extent and reversibility of perfusion defect on the automatic measurement of LVM by QGS and to investigate the effect of reversibility of perfusion defect on post-stress LV dysfunction. Subjects and Methods: Forty-six patients (male/female=34:12, mean age=64years) with perfusion defect on myocardial perfusion SPECT underwent rest and post-stress QGS. Forty patients (87%) showed reversible defect. End-diastolic volume (EDV), end-systolic volume (ESV), LV ejection fraction (EF), and LV myocardial volume were obtained from QGS by AutoQUANT program, and LVM was calculated by multiplying the LV myocardial volume by the specific gravity of myocardium. Results: LVMs measured at rest and post-stress QGS showed good correlation, and higher correlation was founded in the subjects with fixed perfusion defect and with small defect (smaller than 20%). There were no significant differences in EDVs, ESVs and EFs between obtained by rest and post-stress QGS in patients with fixed myocardial defect. Whereas, EF obtained post-stress QGS was lower than that by rest QGS in patients with reversible defect and 10 (25%) of them showed decreases in EF more than 5% in post-stress QGS, as compared to that of rest QGS. Excellent correlations of EDVs, ESVs, EFs between rest and post-stress QGS were noted. Patients with fixed defect had higher correlation between EDVs, ESVs, EFs than patients with reversible defect. Conclusion: These results suggest that perfusion defect can affect LVM measurement by QGS and patients with reversible defect shows post-stress LV dysfunction more frequently than patients with fixed perfusion defect. (Korean J Nucl Med 2002;36;381-91)