Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test
Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test
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DOI：
10.1016/s0735-1097(99)00231-4
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发表时间：
1999-08-01
影响因子：
24
通讯作者：
Chierchia, SL
中科院分区：
文献类型：
--
作者：
Fragasso, G;Lu, CZ;Chierchia, SL
虽然不同的非侵入性测试已被提出用于检测冠状动脉疾病（CAD）的高血压和胸痛症状的患者，可用的技术的相对性能还没有被系统地assessed.Background高血压患者经常抱怨胸痛，并表现出缺血样ST段变化的运动心电图（ECG）。然而，这种变化预测严重CAD的特异性非常低，因为这些患者通常表现出正常的冠状动脉血管造影。方法对101例患有高血压、胸痛和运动心电图阳性的患者，我们使用99 mTc-MIBI、双嘧达莫和多巴酚丁胺进行了负荷/静息心肌单光子发射计算机断层扫描负荷超声心动图和冠状动脉造影。所有患者的整体心室功能正常，57例左心室肥厚。所有患者在研究期间均持续使用ACE抑制剂。结果在灌注造影过程中，无患者出现明显的副作用。在5例双嘧达莫患者和7例多巴酚丁胺患者中观察到剂量限制性副作用。只有56%的研究患者表现出严重的CAD。灌注动脉造影的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98%、36%、71%、67%和94%，潘生丁为61%、91%、74%、90%和64%，85%和83%多巴酚丁胺负荷超声心动图。结论这项研究表明，高血压患者的负荷超声心动图产生了令人满意的诊断准确性，以确定显着的心外膜CAD。结果提示多巴酚丁胺可能上级优于潘生丁。心肌造影的低特异性可能与该方法跟踪灌注异常有关，不一定是心外膜CAD引起的，可能是由于微血管疾病引起的，不会引起明显的室壁运动异常。(C)1999年由美国心脏病学会。
OBJECTIVES Although different noninvasive tests have been proposed for detecting coronary artery disease (CAD) in patients with hypertension and chest pain symptoms, the relative performance of the available techniques has not been systematically assessed.BACKGROUND Patients with hypertension frequently complain of chest pain and exhibit ischemic-like ST segment changes on the exercise electrocardiogram (ECG). However, the specificity of such changes for predicting significant CAD is very low, because these patients often exhibit a normal coronary angiogram.METHODS In 101 patients with hypertension, chest pain and positive exercise EGG, we performed stress/rest myocardial single photon emission computed tomography with 99mTc-MIBI, dipyridamole and dobutamine stress echocardiography and coronary angiography. All patients had normal global ventricular function and 57 had left ventricular hypertrophy. All were kept on ACE inhibitors during the study period.RESULTS No patients had significant side effects during perfusion scintigraphy. Dose-limiting side effects were observed in five patients with dipyridamole and in seven patients with dobutamine. Only 56% of study patients exhibited significant CAD. Sensitivity, specificity, accuracy, positive and negative predictive values were, respectively, 98%, 36%, 71%, 67% and 94% for perfusion scintigraphy, 61%, 91%, 74%, 90% and 64% for dipyridamole and 88%, 80%, 84%, 85% and 83% for dobutamine stress echocardiography.CONCLUSIONS This study shows that stress echo in patients with hypertension yields a satisfactory diagnostic accuracy for identifying significant epicardial CAD. Our results indicate that dobutamine might be superior to dipyridamole. The low specificity of myocardial scintigraphy probably relates to the fact that this method traces perfusion abnormalities, not necessarily caused by epicardial CAD, possibly due to microvascular disease and not causing obvious wall motion abnormalities. (C) 1999 by the American College of Cardiology.