Positive exercise thallium-201 test responses in patients with less than 50% maximal coronary stenosis: angiographic and clinical predictors.
Positive exercise thallium-201 test responses in patients with less than 50% maximal coronary stenosis: angiographic and clinical predictors.
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阳性%20运动%20铊-201%20测试%20反应%20在%20患者%20中%20少于%20%2050%%20最大%20冠状%20狭窄：%20血管造影%20和%20临床%20预测因子。
DOI：
10.1016/0002-9149(85)90298-x
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Okada,RD
中科院分区：
文献类型：
--
作者：
Brown,KA;Osbakken,M;Boucher,CA;Strauss,HW;Pohost,GM;Okada,RD
在无明显冠状动脉疾病的情况下，检查了铊-201（Tl-201）心肌灌注研究异常的发生率和原因。研究组包括100名连续患者，他们接受了运动Tl-201试验和冠状动脉造影，发现冠状动脉最大直径狭窄小于50%。最大冠状动脉狭窄范围为0 - 40%。通过logistic回归分析评估患者临床、运动和血管造影数据的独立和相对影响。阳性应激Tl-201试验结果的显著预测因素为：（1）最大冠状动脉狭窄百分比（p < 0.0005），（2）普萘洛尔使用（p < 0.01），（3）普萘洛尔使用与最大狭窄百分比的相互作用（p < 0.005），以及（4）应激诱发的胸痛（p = 0.05）。没有其他患者变量具有显著影响。最大狭窄21 - 40%的患者（59%）的Tl-201检测结果阳性率高于最大狭窄0 - 20%的患者（27%）（p < 0.01）。在狭窄21 - 40%的患者中，当达到最大预测心率的85%时（75%）的阳性测试反应比未达到最大预测心率的（40%）更常见（p < 0.05）。在21 - 40%最大狭窄的患者中观察到的16个非心尖灌注缺损中，14个位于与这种冠状动脉狭窄相对应的区域。服用普萘洛尔的患者（45%）比未服用普萘洛尔的患者（22%）更有可能出现TI-201检测结果阳性（p < 0.05）。虽然有应激性胸痛的患者比没有胸痛的患者更经常有阳性的Tl-201测试结果，但这种差异没有达到统计学意义。但在典型心绞痛时，Tl-201灌注缺损的发生率高于非典型胸痛时（p < 0.05）。与21%至40%狭窄相关的Tl-201缺陷的高频率以及此类缺陷与由这些狭窄供应的心肌区域的密切相关性表明，此类冠状动脉病变可能具有真正的血流动力学影响，特别是在高水平的应力下。此外，在服用普萘洛尔的患者中进行的阳性Tl-201研究的高发生率表明，应尝试在Tl-201运动试验前使患者停用β受体阻滞剂治疗。
The incidence and causes of abnormal thallium-201 (Tl-201) myocardial perfusion studies in the absence of significant coronary artery disease were examined. The study group consisted of 100 consecutive patients undergoing exercise Tl-201 testing and coronary angiography who were found to have maximal coronary artery diameter narrowing of less than 50%. Maximal coronary stenosis ranged from 0 to 40%. The independent and relative influences of patient clinical, exercise and angiographic data were assessed by logistic regression analysis. Significant predictors of a positive stress Tl-201 test result were: (1) percent maximal coronary stenosis (p < 0.0005), (2) propranolol use (p < 0.01), (3) interaction of propranolol use and percent maximal stenosis (p < 0.005), and (4) stress-induced chest pain (p = 0.05). No other patient variable had a significant influence. Positive Tl-201 test results were more common in patients with 21 to 40% maximal stenosis (59%) than in patients with 0 to 20% maximal stenosis (27%) (p < 0.01). Among patients with 21 to 40% stenosis, a positive test response was more common when 85 % of maximal predicted heart rate was achieved (75%) than when it was not (40%) (p < 0.05). Of 16 nonapical perfusion defects seen in patients with 21 to 40% maximal stenosis, 14 were in the territory that corresponded with such a coronary stenosis. Patients taking propranolol were more likely to have a positive Tl-201 test result (45%) than patients not taking propranolol (22%) (p < 0.05). Although patients with stress-induced chest pain more often had a positive Tl-201 test result than those without chest pain, this difference did not reach statistical significance. However, Tl-201 perfusion defects were more frequently seen when typical angina pectoris was elicited than when atypical chest pain developed (p < 0.05). The high frequency of Tl-201 defects associated with 21 to 40% stenoses and the close correlation of such defects with myocardial territory supplied by these stenoses suggests that such coronary lesions may have true hemodynamic impact, especially at high levels of stress. In addition, the high incidence of positive Tl-201 studies in patients taking propranolol suggests that an attempt be made to wean patients off β-blocker treatment before Tl-201 exercise testing.