INCREMENTAL VALUE OF SIMULTANEOUS ASSESSMENT OF MYOCARDIAL-FUNCTION AND PERFUSION WITH TC-99M SESTAMIBI FOR PREDICTION OF EXTENT OF CORONARY-ARTERY DISEASE
INCREMENTAL VALUE OF SIMULTANEOUS ASSESSMENT OF MYOCARDIAL-FUNCTION AND PERFUSION WITH TC-99M SESTAMIBI FOR PREDICTION OF EXTENT OF CORONARY-ARTERY DISEASE
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DOI：
10.1016/0735-1097(94)00523-s
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发表时间：
1995-04-01
影响因子：
24
通讯作者：
BERMAN, DS
中科院分区：
文献类型：
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作者：
PALMAS, W;FRIEDMAN, JD;BERMAN, DS
目标。本研究评估了锝-99m心肌单光子发射计算机断层扫描（SPECT）和同时首过放射性核素血管造影在跑步机运动时的增量价值，用于预测冠状动脉疾病的程度。锝-99m计数统计允许同时评估心肌灌注和功能，然而，这一特征是否能提高冠状动脉疾病程度的预测仍然未知。我们研究了70名连续的患者，他们在6个月内进行了冠状动脉造影。所有患者都进行了症状受限的跑步机运动试验。跑步机数据使用先前验证的评分进行汇总。左心室射血分数和局部壁运动通过前视图在跑步机运动高峰时获得的第一次放射性核素血管造影进行评估，灌注进行视觉评估。血管造影疾病的程度表示为是否存在多支血管疾病（超过两个冠状动脉区域，>狭窄50%），并作为反映严重狭窄（>狭窄75%）位置的评分。逐步将血管造影数据（先灌注后功能）添加到跑步机评分中，每一步血管造影评分的预测都有显著的增量价值；运动射血分数是最强的独立预测因子。通过在跑步机评分中加入灌注信息和在两者中加入区域壁运动分析，也提高了检测多血管疾病的判别准确性。在本例中，射血分数未能显示出独立的值。在跑步机运动试验中同时进行sestamibi灌注SPECT和第一次放射性核素血管造影，可显著提高对冠状动脉疾病程度的预测。
Objectives. This study assessed the incremental value of technetium-99m myocardial single photon emission computed tomography (SPECT) and simultaneous first-pass radionuclide angiography, when added to treadmill exercise, for prediction of the extent of coronary artery disease.Background. Technetium-99m count statistics permit the simultaneous assessment of myocardial perfusion and function, However, whether this characteristic improves prediction of the extent of coronary artery disease remains unknown.Methods. We studied 70 consecutive patients who had coronary angiography within 6 months of the scintigraphic study. All patients underwent a symptom-limited treadmill exercise test. Treadmill data were summarized using a previously validated score. Left ventricular ejection fraction and regional wall motion were evaluated from a first pass radionuclide angiogram acquired at peak treadmill exercise in the anterior view, Perfusion was assessed visually. Extent of angiographic disease was expressed as the presence or absence of multivessel disease (more than two coronary artery territories with >50% stenosis) and as a score that reflects the location of severe (>75%) stenosis.Results. Stepwise addition of scintigraphic data (perfusion first, followed by function) to the treadmill score showed significant incremental value for prediction of the angiographic score at each step; exercise ejection fraction alone was the strongest independent predictor. Discriminant accuracy for detection of multivessel disease was also improved by the addition of perfusion information to the treadmill score and addition of regional wall motion analysis to both of them. In this case, ejection fraction failed to show independent value.Conclusions. The addition of simultaneously performed sestamibi perfusion SPECT and first pass radionuclide angiography to the treadmill exercise test significantly improved prediction of the extent of coronary artery disease.