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Kokyu to Junkan Volume 43, Issue 8 （August 1995）

呼吸と循環 43巻8号（1995年8月発行）

Japanese English

研究

拡張型心筋症における脂肪酸代謝イメージングとその有用性 Myocardial Imaging With β-methyl-p-(¹²³I) iodophenyl-pentadecanoic acid in Patients with Dilated Cardiomyopathy and its Usefulness 成田充啓 ¹ , 栗原正 ¹ , 新藤高士 ¹ , 宇佐美暢久 ¹ Michihiro Narita ¹ , Tadashi Kurihara ¹ , Takashi Sindoh ¹ , Masahisa Usami ¹ ¹住友病院内科 ¹Department of Internal Medicine, Sumitomo Hospital キーワード： ¹²³Iヨードフェニールメチルベンタデカン酸 , 心筋イメージング , 拡張型心筋症 , ¹²³I-iodophenyl methylpentadecanoic acid , myocardial imaging , dilated cardiomyopathy Keyword: ¹²³Iヨードフェニールメチルベンタデカン酸 , 心筋イメージング , 拡張型心筋症 , ¹²³I-iodophenyl methylpentadecanoic acid , myocardial imaging , dilated cardiomyopathy pp.795-800

発行日 1995年8月15日 Published Date 1995/8/15

DOI https://doi.org/10.11477/mf.1404901101

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Abstract 文献概要
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　目的：拡張型心筋症（DCM）における心筋脂肪酸代謝障害の有無，特徴を検討し，併せてその予後判定における有用性も検討した．方法：対象はDCM14例，健常例（N）9例である．安静時に¹²³I-ヨードフェニールペンタデカン酸（PP），²⁰¹Tl（Tl）心筋イメージング（全身像と断層像）を撮像した．PP,Tlの心筋への集積をもとに，心筋へのPPの取り込みをUptake Ratio（UR）で示した．心筋内PP分布の不均一性の定量（CV），欠損の広がりの定量も行った．結果：DCMのURはNに比し有意（p＜0.01）に低く，URは左心機能を反映した．また，DCMにおけるPPのCVはNより有意（p＜0.01）に大で，PPのCVは血中ノルエピネフリンレベル，心房性Na利尿ペプタイドを反映していた．DCMにおいてPPの欠損は64％に出現し，広がりはTlの欠損より大なる症例が多かった．結語：DCMにおいては心筋脂肪酸代謝障害が存在する．この代謝障害は心筋血流障害や壊死に先立って出現する．かつ，脂肪酸代謝障害の定量的検討はDCMの予後判定にも有用と思われた．

To investigate the usefulness of myocardial imaging with β-methyl-p-(¹²³I) iodophenyl-pentadecanoic acid (BMIPP) in the assessment of dilated cardiomyopathy (DCM), we studied 14 patients with DCM and 9 normal subjects.

Rest myocardial imaging (tomography and planar whole-body imaging) with BMIPP and ²⁰¹Tl (Tl) was performed on separate days. From the whole body imaging, cardiac accumulation of the radionuclide compared to the total injected dose was calculated (% Uptake). Uptake Ratio (%Uptake of MIBG divided by %Uptake of Tl) was used as an index of myocardial MIBG uptake which was normalized by myocardial mass. And we also calculated the coefficient of varia-tion (CV) for each isotope as the index of un-homogeniety of isotope distribution within the myocar-dium.

Uptake Ratio was significantly lower in patients with DCM (0.95±0.15) than in normal subjects (1.13±0.08) (p＜0.01). In addition, Uptake Ratio correlated well with fractional shortening (%FS) (r=0.69, p＜0.01) and left ventricular ejection fraction (r=0.70, p＜ 0.01). CV of BMIPP imaging in patients with DCM was greater than that in normal subjects, but there was no difference between DCM and normal subjects in CV of Tl imaging. CV of BMIPP correlated well with serum norepine-phrine level (r=0.59, p＜0.05) and atrial natriuretic peptide (r=0.73, p＜0.01). In patients with DCM, regional abnormality (defect) appeared in 9 patients (64%) both in BMIPP and Tl imaging, but the size of the defect was generally greater in patients with DCM than in normal subjects.

These results suggested that in patients with DCM, disturbance of myocardial fatty acid metabolisml appeared before perfusion abnormality and/or myocar-dial necrosis became apparent. The quantification of BMIPP imaging may be useful for assessing the progno-sis for patients with DCM.