Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease
Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease
复制标题
DOI：
10.1016/j.nuclcard.2007.05.008
复制
发表时间：
2007-07-01
影响因子：
2.4
通讯作者：
Germano, Guido
中科院分区：
文献类型：
--
作者：
Berman, Daniel S.;Kang, Xingping;Germano, Guido
背景资料。门控单光子发射计算机断层扫描(SPECT)心肌灌注成像(MPI)对左主干病变(CAD)的诊断价值资料有限。方法和结果。我们研究了101例冠状动脉左主干病变(狭窄50%)且既往无心肌梗死或冠状动脉血运重建的患者，这些患者接受了门控运动或腺苷负荷~(99m)Tc-SPECT MPI。仅通过血流灌注评估，只有56%的患者在视觉上和59%的定量上被识别出具有中到重度缺陷的高危疾病(>；10%的应激心肌)。13%的患者在视觉上和15%的定量上没有明显的血流灌注缺陷(心肌<5%)。然而，结合视觉灌注数据和非灌注变量，特别是短暂性脑缺血扩张，83%的患者被确定为高危患者。这项研究的结果表明，仅通过目测或定量SPECT MPI分析来评估灌注数据低估了左主干的大小。门控MPI上的血流和非血流灌注异常相结合，在大多数左主干冠心病患者中识别出高风险。
Background. There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of left main coronary artery disease (CAD).Methods and Results. We studied 101 patients with angiographic left main CAD (>= 50% stenosis) and no prior myocardial infarction or coronary revascularization who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk disease with moderate to severe defects (>10% myocardium at stress) was identified in only 56% of patients visually and 59% quantitatively. Absence of significant perfusion defect (>= 5% myocardium) was seen in 13% of patients visually and 15% quantitatively. However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients were identified as high risk.Conclusions. The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies high risk in most patients with left main CAD.