ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates.
ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates.
复制标题
双嘧达莫输注期间 ST 段压低及其临床、闪烁扫描和血流动力学相关性。
DOI：
10.1016/0002-9149(92)90982-5
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Beller,GA
中科院分区：
文献类型：
--
作者：
Villanueva,FS;Smith,WH;Watson,DD;Beller,GA
本研究的目的是确定双嘧达莫诱导的st段下降是否比没有这种心电图发现反映更严重或更广泛的心肌灌注不足。本文对204例连续接受双嘧达莫应激铊-201 （Tl-201）显像评估冠状动脉疾病的患者，研究了静脉滴注双嘧达莫期间st段凹陷的临床、血流动力学和显像相关因素。182例基线心电图诊断患者中，28例（15%）在使用双嘧达莫后出现ST段抑郁。ST段抑郁患者与无ST段抑郁患者相比，在使用双嘧达莫后年龄更大（64±1岁vs 60±1岁；p < 0.03），胸痛频率更高（57 vs 23%; p < 0.001），心率-血压产物更高（12.7±0.6 vs 11.2±0.2 × 103; p < 0.008）。与无ST段抑郁的患者相比，有ST段抑郁的患者更容易出现Tl-201再分配（64% vs 38%, p < 0.02），再分配缺陷数量也更多（2.3±0.04 vs 0.9±0.1,p < 0.001）。经多因素logistic回归分析，与ST抑郁最相关的是Tl-201再分布的节段数（p < 0.001）。其他独立的相关因素是胸痛、注射Tl-201时的心率和年龄。因此，双嘧达莫诱导的st段下降的决定因素包括可逆性低灌注的闪烁程度以及心肌需氧量指标。
The goal of this study was to determine whether dipyridamole-induced ST-segment depression reflects more severe or extensive myocardial hypoperfusion than the absence of this electrocardiographic finding. The clinical, hemodynamic and scintigraphic correlates of ST-segment depression during intravenous dipyridamole infusion were studied in 204 consecutive patients undergoing dipyridamole stress thallium-201 (Tl-201) imaging for evaluation of coronary artery disease. Of 182 patients with a diagnostic baseline electrocardiogram, 28 (15%) developed ST depression after dipyridamole. Patients with ST depression, compared with those without, were older (64 ± 1 vs 60 ± 1 years; p < 0.03) and had a higher frequency of chest pain (57 vs 23%; p < 0.001) and a higher heart rate-blood pressure product (12.7 ± 0.6 vs 11.2 ± 0.2 × 103; p < 0.008) after dipyridamole. Patients with ST depression were more likely to have Tl-201 redistribution (64 vs 38%; p < 0.02) and a greater number of redistribution defects (2.3 ± 0.04 vs 0.9 ± 0.1, p < 0.001) than were those without ST depression.By multivariate logistic regression analysis, the most powerful correlate of ST depression was the number of segments having Tl-201 redistribution (p < 0.001). Other independent correlates were presence of chest pain, heart rate at Tl-201 injection, and age. Thus, the determinants of dipyridamole-induced ST-segment depression include the scintigraphic extent of reversible hypoperfusion, as well as indexes of myocardial oxygen demand.