Sensitivity, Specificity and Predictive Accuracy of Radionuclide Cineangiography During Exercise in Patients with Coronary Artery Disease: Comparison with Exercise Electrocardiography
Sensitivity, Specificity and Predictive Accuracy of Radionuclide Cineangiography During Exercise in Patients with Coronary Artery Disease: Comparison with Exercise Electrocardiography
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冠状动脉疾病患者运动期间放射性核素血管造影的敏感性、特异性和预测准确性：与运动心电图的比较
DOI：
10.1161/01.cir.60.3.572
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发表时间：
1979
期刊：
影响因子：
37.8
通讯作者：
G. Johnston
中科院分区：
文献类型：
--
作者：
J. Borer;K. Kent;S. Bacharach;M. Green;D. Rosing;S. Seides;S. Epstein;G. Johnston
无创性放射性核素电影血管造影术可以评价剧烈运动时左心室整体和局部功能。为了评估该技术检测冠状动脉疾病的灵敏度，我们研究了63例至少一条冠状动脉狭窄≥ 50%的连续患者。59例（94%）运动时出现局部功能障碍; 56例（89%）运动时射血分数低于正常。当同时考虑局部功能障碍和射血分数低于正常时，敏感性为95%。每例患者还接受了运动心电图，以心绞痛或85%的预测最大心率。在运动心电图期间发生心绞痛的42例患者中，26例（62%）ST段压低≥1 mm;另外4例患者（10%）的Q波诊断为既往心肌梗死。相比之下，39例（93%，p < 0.001）在放射性核素研究中出现局部功能障碍，另外1例患者出现射血分数低于正常，但无局部功能障碍。为了评估特异性，我们研究了21例冠状动脉正常的胸痛患者。没有发生局部功能障碍;射血分数增加到以前定义为正常范围内的水平。在这一有症状人群中的预测准确率为100%。我们的结论是，放射性核素电影血管造影是高度敏感的（比运动心电图），预测性和特异性检测冠心病患者。
Noninvasive radionuclide cineangiography permits the assessment of global and regional left ventricular function during intense exercise. To assess the sensitivity of the technique in detecting coronary artery disease, we studied 63 consecutive patients with ≥ 50% stenosis of at least one coronary artery. Fiftynine (94%) had regional dysfunction with exercise; 56 (89%) developed lower-than-normal ejection fractions during exercise. When both regional dysfunction and subnormal ejection fractions are considered together, the sensitivity was 95%. Each patient also underwent exercise electrocardiography to either angina or 85% of predicted maximal heart rate. Of the 42 patients who developed angina during exercise electrocardiography, 26 (62%) developed ≥1 mm ST-segment depression; four additional patients (10%) had Q waves diagnostic of previous myocardial infarction. In contrast, 39 (93%, p < 0.001) developed regional dysfunction during radionuclide study, and one additional patient developed a subnormal ejection fraction without regional dysfunction. To assess specificity, we studied 21 consecutive patients with chest pain who had normal coronary arteries. None developed regional dysfunction; ejection fraction increased in all to levels within the range previously defined as normal. The predictive accuracy in this symptomatic population was 100%. We conclude that radionuclide cineangiography is highly sensitive (more so than exercise electrocardiography), predictive and specific in detecting patients with coronary artery disease.