배경 : 최근 게이트 심근 관류 SPECT의 발달은 관상동맥 질환의 진단뿐만 아니라 그정도를 예측하는데 많은 도움을 주고 있다. 또 한 번의 검사로 심근의 관류상태외에도 심근벽의 운동, 두께, 좌심실 구혈율을 관찰할 수 있게 하였으며 부하 후 좌심실 구혈율의 변화를 보여 줄 수 있다. 본 연구에서는 운동 부하 후 좌심실 구혈율의 감소가 있는 환자와 그렇지 않은 환자 사이에 임상소견 및 관상동맥 조영술 소견에 어떠한 차이가 있는지를 알아보고자 하였다. 방법 : 2001년 5월에서 2002년 5월까지 본원에서 허혈성 심질환이 의심되어 운동 부하 심전도 및 게이트 심근 관류 SPECT 검사를 받은 환자군 중 6개월내 관상동맥 조영술을 시행한 환자를 대상으로 하였다. 본 연구에서는 심근기절을 부하 후 좌심실 구혈율이 휴식시보다 5% 이상 차이가 나는 경우로 정의하였다. 대상 환자 41명 중 기절심근군이 16명, 비기절심근군이 25명이었다.결과 : 기절심근군에서 비기절심근군보다 고지혈증의 빈도가 높았으며 당뇨의 빈도가 높은 경향을 가졌으나 다른 위험 인자들은 유의한 차이를 보이지 않았다. 또한 운동부하 심전도 검사에서 양성율이 높았며 운동 능력은 감소되어 있었다. 기절심근군에서 비기절심근군보다 관상동맥이 90% 이상, 99% 이상 협착된 환자수가 유의하게 많았으며 2개 이상의 주요 관상동맥이 협착된 환자수에서도 유의하게 많았다. 결론 : 운동 부하 후 좌심실 구혈율이 감소한 환자는 그렇지 않은 군에 비해 심한 관상동맥 질환의 빈도가 높아, 부하 후 좌심실 구혈율의 감소는 허혈성 질환의 정도를 시사하는 중요한 지표로서의 가능성을 보여주고 있다.

Background : Gated myocardial perfusion SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls, ejection fraction as well as myocardial perfusion. Many studies suggested that there was a decrease of left ventricular ejection fraction (LVEF) at post-stress compared with that at rest gated myocardial perfusion SPECT (stunning). The objective of this retrospective study is to evaluate the clinical significance of the decrease of LVEF at post-stress gated myocardial perfusion SPECT by correlating with coronary angiographic finding. Methods : Authors selected 41 patients who underwent exercise electrocardiography and gated myocardial perfusion SPECT between May, 2001 and May, 2002. The patients underwent coronary angiography within 6 months. The patients were divided into two groups, 16 patients in whom post-stress LVEF was ≥5% lower than rest (stunning group) and 25 patients in whom LVEF was not ≥5% lower than rest (non-stunning group). Results : The number of patients with hyperlipidemia was higher in stunning group than in non-stunning group (50% vs 4%, p=0.001). The number of patients with angiographic stenoses >90% was significantly higher in stunning group than in non-stunning group (75% vs 28%, p=0.04). The number of patients with multi-vessel disease was also significantly higher in stunning group than in non-stunning group (75% vs 36%, p=0.015). Conclusion : The patients who had a decreased LVEF after stress (stunning) showed more severe coronary artery stenosis. This finding suggests that stunning may be an important additional indicator of underlying myocardial ischemia.

Background : Gated myocardial perfusion SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls, ejection fraction as well as myocardial perfusion. Many studies suggested that there was a decrease of left ventricular ejection fraction (LVEF) at post-stress compared with that at rest gated myocardial perfusion SPECT (stunning). The objective of this retrospective study is to evaluate the clinical significance of the decrease of LVEF at post-stress gated myocardial perfusion SPECT by correlating with coronary angiographic finding. Methods : Authors selected 41 patients who underwent exercise electrocardiography and gated myocardial perfusion SPECT between May, 2001 and May, 2002. The patients underwent coronary angiography within 6 months. The patients were divided into two groups, 16 patients in whom post-stress LVEF was ≥5% lower than rest (stunning group) and 25 patients in whom LVEF was not ≥5% lower than rest (non-stunning group). Results : The number of patients with hyperlipidemia was higher in stunning group than in non-stunning group (50% vs 4%, p=0.001). The number of patients with angiographic stenoses >90% was significantly higher in stunning group than in non-stunning group (75% vs 28%, p=0.04). The number of patients with multi-vessel disease was also significantly higher in stunning group than in non-stunning group (75% vs 36%, p=0.015). Conclusion : The patients who had a decreased LVEF after stress (stunning) showed more severe coronary artery stenosis. This finding suggests that stunning may be an important additional indicator of underlying myocardial ischemia.

Gated myocardial perfusion SPECT; Myocardial stunning; Coronary artery stenosis