心肌灌注與心超檢查結果分析-心臟血管專科

心超及心肌灌注檢查？

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Dear 蔡醫師
父親年齡：72，體重：47
下文為父親心肌灌注與心超報告，因父親於2022.7.18因急性心肌梗塞於成大做心臟支架手術*1（右冠血管），當時醫師說明左心上迴旋與左前肢狀態有阻塞，需考量creatinine 2.0以下（目前檢查值2.29），以下才能再進行第二支架放置術（預計會有3支支架，目前蛋白控制0.6、腎功能4期，腎絲球過濾28，想諮詢目前這兩份檢查報告內容及是否有急迫性手術需求，需要注意事項。
感謝醫師說明，感激不盡。
心肌灌注報告
NUCLEAR MEDICINE STUDY: Thallium-201 myocardial perfusion imaging (MPI) dipyridamole ＆ resting.
RADIOPHARMACEUTICAL: Intravenous 2.0 mCi Tl-201 (Thallium-201).
Reason for MPI: Diagnosis of CAD.
Symptoms/signs: DOE for years.
Risk factors: HTN DM dyslipidemia CKD male sex and old age.
Previous cardiac examinations: Cardiac echo (2022/09/14) showed normal LV systolic function.
Previous intervention: nil
SCINTIGRAPHIC FINDINGS: Tl-201 SPECT was performed after standardized dipyridamole stress protocol (dipyridamole: 0.56mg/kg continuous IV push in 4 minutes; and aminophylline 83mg IV infusion prn for relief of adverse reactions) and resting state.
* Baseline ECG showed Q wave and TWI at inferior leads. There was no dynamic ST-T change during dipyridamole infusion.
* No discomfort was noted during stress.
* The initial and 4-hour delayed images showed (1) moderate reversible perfusion defect at lateral wall; (2) the lung-heart ratio was within normal limit (stress/rest=0.31/0.42).
心超報告
年齡: 71 Years :
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Conclusions
Concentric left ventricular hypertrophy
The LV systolic function is normal
The transmitral spectral Doppler flow pattern is suggestive of impaired LVrelaxation.
There are regional wall motion abnormalities as specified.
Tricuspid regurgitation moderate
Low probability of Pulmonary hypertension.
Aortic regurgitation mild-moderate
Mitral regurgitation moderate

M Mode /2D Measurements ＆ Calculatents
IVSd: 1.29 cm LVIDd: 4.3 cm IVS/LVPW: 0.92 EDV(cubed): 77.3 mlLA/Ao: 1.11 LV mass(C)d: SV(Teich): 41.8 ml
214.9 grams
LVIDs: 3.1 cm FS: 26.1 % ESV(cubed): 31.3ml SV(cubed): 46.0 ml
LVPWd: 1.40 cm EDV(Teich): 81.2 ml EF(cubed): 59.6 %
RWT_: 0.66 ESV(Teich): 39.4 ml
EF(Teich): 51.5 %
Ao root diam:
3.0 cm
ACS: 1.47 cm
LA dimension:
3.4 cm

Doppler Measurements ＆Calculations
MV E max vel: TR max PG: 27.9 mmHg MV dec time: Ao V2 max: PA V2 max: 68.4cm/sec Med E’ Vel: 3.0 cm/sec
43.2 cm/sec 0.20 sec 148.7 cm/sec
MV A max vel: E/ Med E’: 14.2 Ao max PG: 8.8 mmHg
101.2 cm/sec
MV E/A: 0.43 Lat E’ Vel: 5.5 cm/sec
E /Lat E’: 7.8

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: I :
: WMSI = 1.06 % Normal = 94% :
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: X - 1 - 2 - 3 - 4 - 5 - :: Segments : Size ::
: Cannot Interpret Normal Hypokinetic Akinetic Dyskinetic Aneurysmal :: : : :
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: :: 1-2 : small : :
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: :: 3-5 : moderate : :
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: :: 6-14 : large : :
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: :: 15-16 : diffuse : :
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Left Ventricle
Concentric left ventricular hypertrophy. The LV systolic function is normal.The transmitral spectral Doppler flow pattern is suggestive of impaired LVrelaxation. There are regional wall motion abnormalities as specified.
Left Atrium
The left atrial size is normal.
Right Heart
The right ventricle is normal in size and function. Normal right atrial size.Tricuspid regurgitation moderate. Low probability of Pulmonary hypertension.
Aortic Valve
Fibrocalcified degenerationwith satisfactory opening. Aortic regurgitationmild-moderate.
Mitral Valve
Myxomatous. Mitral regurgitation moderate.

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以上，感激不盡

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王彤湲，40~49歲女性，詢問日期：2022/09/15