Ganzkörperverteilung von Tc-99m-Sestamibi nach pharmakologischer Belastung mit Arbutamin und Dipyridamol im Vergleich zum Ruhezustand

Zusammenfassung

Ziel: Der neue Beta-adrenerge Rezeptoren-Agonist Arbutamin (GenESA^®, Gensia Europe Ltd., Berkshire, England) wurde speziell für den pharmakologischen Streß zum Nachweis einer koronaren Herzerkrankung entwickelt und stellt damit auch für die Belastungsmyokardszintigraphie eine Option dar. Die pharmakologische Wirkung kann im Vergleich zum Vasodilatator Dipyridamol anhand der Ganzkörper-Aktivitätsverteilung nach Applikation von Tc-99m-Sestamibi bestimmt werden. Methoden: Untersucht wurden 9 Patienten nach Applikation von Tc-99m-Sestamibi unter Ruhebedingung, nach Steigerung der myokardialen Perfusion durch Infusion von Arbutamin und unter maximaler Vasodilatation durch Infusion von Dipyridamol. Ergebnisse: Nach Gabe von Arbutamin bestand eine szintigraphisch meßbare verminderte Radiotracereinlagerung in der unteren Extremität. Gegenüber Dipyridamol war die myokardiale Akkumulation von Tc-99m-Sestamibi trotzdem vermindert, was sich neben dem relativen Anteil des Herzens an der Ganzkörperaktivität (2,1% ± 0,5% gegenüber 2,4% ± 0,4%, p <0,05) auch an einem niedrigeren Herz-Lungen-Quotienten (2,5 ± 0,4 gegenüber 2,8 ± 0,5, p <0,05) zeigte. Schlußfolgerung: Nach Infusion von Arbutamin ist sowohl der Anteil von myokardial deponiertem Tc-99m-Sestamibi als auch der Kontrast des Myokards zur umgebenden Lunge geringer als nach Gabe von Dipyridamol. Ob dieser Unterschied für die Diagnose myokardialer Perfusionsstörungen mit Tc-99m-Sestamibi relevant ist, muß noch überprüft werden.

Summary

Aim: Arbutamine is a new catecholamine that has been developed as a pharmacologic stress agent for the diagnosis of coronary artery disease. Optionally, it can be used in myocardial scintigraphy. The pharmacologic effect compared to dipyridamole was assessed looking at the whole body distribution of Tc-99m-Sestamibi. Methods: 9 patients were investigated after injection of Tc-99m-Sestamibi during rest, after infusion of arbutamine, and after vasodilatation with dipyridamole. Results: Infusion of arbutamine results in a measurable diminished radiotracer deposition in the lower limb as compared to dipyridamole. The amount of myocardial activity of Tc-99m-sestamibi, however, is also reduced as shown by the percentage of myocardial acitivity compared to the whole body distribution (2.5% ± 0.4% for arbutamine vs. 2.8% ± 0.5% for dipyridamole). In addition, the heart/lung ratio is lower after application of arbutamine (2.1 % ± 0.5% vs. 2.4% ± 0.4%). Conclusion: After infusion of arbutamine the percentage of myocardial activity as well as the contrast of the myocardium to the surrounding lungs is decreased as compared to dipyridamole. Further studies should reveal whether this difference is relevant in diagnosing coronary artery disease.

Schlüsselwörter

Arbutamin - Streß-Test - Myokardszintigraphie

Keywords

Arbutamine - stress tests - perfusion scintigraphy

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