逆向再分佈的心肌灌注掃描結果分析及其治療建議-心臟血管專科

心肌灌注掃描結果評估？

醫師您好, 小弟今年四月中旬因呼吸困難及心悸不舒服隔日就醫, 先前健檢都有心室早期收縮問題, 這次去醫院做心臟超音波則有好幾個個瓣膜輕微閉鎖不全問題(其中二尖瓣為輕至中度), 不確定跟VPC是否有關, 後續在服用脈律循狀況下做了24小時心電圖顯示有2千多下VPC, 其中還有60幾次的couplet VPC, 做了運動心電圖雖無明顯問題但仍顯示陽性, 在醫生的建議下還是做了心肌灌注掃描, 結果是呈現左心室下壁在壓力態有15-20%的右冠狀動脈心肌區域缺氧/受損, 但休息態反而缺氧或受損區域提高到30-35%, 解釋是"逆向再分佈"的異常狀態(似乎不好判斷)另外這兩個月來因為不知道是心臟問題還是腸胃問題同時也在檢查胃食道逆流及糞便潛血的問題, 加上飯前血糖(106-108)血壓(14x-13X)略高, 開始勤做慢跑運動(每天可跑4-5K)及飲食控制(減碳及進食順序改變), 成效不錯血糖血壓都有回到標準值內, 體重也減了5-6公斤, 不曉得這樣的生活改善跟上述"逆向再分佈"是否有關再來想請問一下依照心肌灌注的結果, 是否建議一定要做心導管(畢竟是侵入式), 或是有可能採取服藥及運動飲食改善的方式監控, 以下是心肌灌注的結果, 先謝謝醫師並請給我建議(目前仍等回診中)檢查項目 :Tl-201 myocardial perfusion scan 1. The stress imaging: The stress imaging following dipyridamole I.V. infusion and the post-dipyridamole SPECT images reveal: mild to moderate hypoperfusion over the inferior wall of the left ventricle. (extent: 15-20% of RCA territory) 2. The resting imaging: As compare to the stress images, this 4-hour redistribution images reveal progressive hypoperfusion over the inferior wall of LV. (extent: 30-35% of RCA territory) Conclusion : Current study reveals progressive moderate hypoperfusion over the inferior wall of LV,(i.e. ”reverse redistribution”), which may suggest moderate myocardial ischemia/injury in RCA area. Please evaluate clinically ＆ we would like to follow up closely. Remark: ”Reverse redistribution” has been shown to associate with (1)post-myocardial infarction events and/or (2) chronic coronary disease (vascular abnormaly, inappropriate wall motion, or decrease resting flow); however, (3) normal variant also should be considered. All those parameters shown in the imaging (e.g. segment scores, TID, LVEF) were derived from the ”Emory Cardiac Toolbox”(ECTb), a software that has been approved by FDA (USA) for cardiac image decision support. However, please be advised that those parameters should be further correlated with clinical features.