estimate myocardial perfusion in patients with idiopatic pulmonary arterial hypertension (IPAH) by scintigraphy untilizing 99mTc-MIBI.Design and method:
In this study we included 11 patients (pts) with IPAH. The average age of the pts was 42,7 yrs. All pts were female. WHO functional class of disease was II-III. All pts had a common complaint of angina-like symptoms. No signs of ischemic heart disease or left main coronary artery compression were found by computed tomography (CT). On the 1step of diagnostic examination we found the pts with ischemic changes on Holter ECG monitoring. In all pts with the identification of ischemic changes were performed scintigraphy untilizing 99mTc-MIBI myocardium at rest and in combination with stress test (veloergometry: Heart Rate (HR)max corresponded to the HRmax at the Holter ECG monitoring).Results:
Scintigraphy untilizing 99mTc-MIBI IPAH pts at rest revealed disturbance of myocardial perfusion right ventricle (RV) (total 10,9 at stress test, 12 at rest) and mainly in interventricular septum (IVS): 40,9 at stress test and 42,18 at rest, which can be considered as areas of fibrosis of varying severity and area. In addition, some pts were registered a decrease of perfusion on other sites: in 18% of pts were registered a decrease of perfusion of the lower wall of the RV; 9% of pts recorded a decrease of perfusion on the anterior wall of the RV; in 45% of pts had a decrease of perfusion of the lateral wall. IPAH pts were characterized by diastolic LV dysfunction mainly and systolic RV dysfunction. In IPAH pts there was a significant decrease of RV perfusion reserve, manifests the appearance of ischemic changes of varying severity, and with corresponding decrease in myocardial contractility functional reserve, that consequently leads to a worsening disorders systolic RV function in the most patients.Conclusions:
identified decrease of perfusion in RV myocardium at rest and stress by veloergometry may be outline the rationale for the conduction of magnetic resonance imaging (MRI) of the heart is necessary to compare scintigraphy with MRI as a high accuracy method of evaluation of anatomical specialty.