山沢　 正則¹, 椎名　 明¹, 藤田　 俊弘¹, 黒田　 敏男¹, 鈴木　 修², 飯野　 智也¹, 野田　 敏剛¹, 夏目　 隆史¹, 柳沼　 淑夫³, 細田　 瑳一⁴

Masanori YAMASAWA¹, Akira SHIINA¹, Tosihiro FUJITA¹, Toshio KURODA¹, Osamu SUZUKI², Tomoya IINO¹, Toshitaka NODA¹, Takashi NATSUME¹, Toshio YAGINUWA³, Saichi HOSODA⁴

¹自治医科大学循環器内科, ²自治医科大学臨床病理部, ³自治医科大学大宮医療センター, ⁴東京女子医科大学日本心臓血圧研究所循環器内科

¹Department of Cardiology, Jichi Medical School, ²Department Clinical Pathology, Jichi Medical School, ³Jichi Medical School, Ohmiya Medical Center, ⁴Department Medical Cardiology, The Heart Institute Japan, Tokyo Women's Medical College

キーワード : Exercise two-dimensional echocardiography, Percutaneous Transluminal Coronary Angioplasty, Coronary Artery Bypass Graft, Angina Pectoris, Myocardial Infarction

Exercise two-dimensional echocardiography (exercise 2DE) was performed in 13 patients with angina pectoris and 4 patients with myocardial infarction before and after successful percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) to observe regional wall motion during a supine ergometer stress test.
Before PTCA/CABG, newly developed or worsening asynergy was induced by exercise in all patients with angina pectoris. After PTCA/CABG, exercise-induced asynergy was improved in 8 patients with angina pectoris. In these patients, the exercise duration became significantly longer after PTCA/CABG (222±151 sec to 485±90 sec, p Three patients underwent PTCA/CABG in the infarcted area. Exercise-induced asynergy of infarcted area was improved in one patient, and the other two patients did not improve after CABG/PTCA. On the other hand exercise-induced asynergy of the noninfarcted area improved in all two patients after CABG.
The findings of exercise 2DE were compared with those of exercise²⁰¹T1 scintigraphy and exercise ECG. Sixteen of these patients had exercise²⁰¹T1 scintigraphy before and after PTCA/CABG. Before PTCA/CABG all 15 patients with exercise-induced asynergy by 2DE showed reversible thallium defects, and after PTCA/CABG 3 of 6 patients with exercise-induced asynergy showed reversible thallium defect. Before PTCA/CABG 12 of 16 patients with exercise-induced asynergy by 2DE were positive by exercise ECG, and after PTCA/CABG only 1 of the 6 patients with exercise-induced asynergy by 2DE was positive by exercise ECG.
It was concluded that exercise 2DE provided reliable and specific information for evaluating myocardial ischemia and was of great value for assessing the effects of PTCA/CABG.