Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing
Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing
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DOI：
10.1007/s00259-014-2864-x
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发表时间：
2015-02-01
影响因子：
9.1
通讯作者：
Henzlova, Milena J.
中科院分区：
文献类型：
--
作者：
Duvall, W. Lane;Savino, John A.;Henzlova, Milena J.
目的以前的文献表明，心肌灌注成像(MPI)对在负荷试验中运动10代谢物(METS)的患者的预后影响很小。考虑到这一点，我们前瞻性地在急诊科(ED)患者中测试了一种临时注射方案，在该方案中，如果患者获得了足够的运动而没有症状和心电图阴性反应，则不会接受放射性同位素注射。方法纳入所有在5年内来急诊科接受负荷测试的患者，作为其ED评估的一部分。考虑采用临时方案的患者包括：运动应激，年龄=85%，运动10次，应激期间无心绞痛症状，且无心电图改变。根据负荷测试结果、全因死亡率和心脏死亡率、随诊心脏测试、随后的血运重建和成本进行比较。结果共有965名患者符合条件，其中192名仅接受运动治疗，773名接受灌注成像。在41.6+/-19.6个月的随访期后，单纯运动组和运动加影像组的全因死亡率相似(2.6%比2.1%，p=0.59)。在单纯运动组中没有心脏死亡。一年后，单纯运动组的重复功能压力测试次数没有差别(1.6%比2.1%，p=0.43)，血管造影术(0%比4.0%，p=0.002)少，费用也低得多(65美元+/-332美元比506美元+/-1,991美元，p=0.002；价值以美元计算)。运动+显像组照射剂量为8.4+/-2.1mSv。结论与标准成像方案相比，临时注射方案具有死亡率低、后续诊断试验少、费用低等优点。如果被采用，它将减少辐射暴露，节省时间，降低医疗成本，而不会损害预后。
Purpose Previous literature suggests that myocardial perfusion imaging (MPI) adds little to the prognosis of patients who exercise >10 metabolic equivalents (METs) during stress testing. With this in mind, we prospectively tested a provisional injection protocol in emergency department (ED) patients presenting for the evaluation of chest pain in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response.Methods All patients who presented to the ED over a 5-year period who were referred for stress testing as part of their ED evaluation were included. Patients considered for a provisional protocol were: exercise stress, age = 85 %, >= 10 METs of exercise, no anginal symptoms during stress, and no ECG changes. Groups were compared based on stress test results, all-cause and cardiac mortality, follow-up cardiac testing, subsequent revascularization, and cost.Results A total of 965 patients were eligible with 192 undergoing exercise-only and 773 having perfusion imaging. After 41.6 +/- 19.6 months of follow-up, all-cause mortality was similar in the exercise-only versus the exercise plus imaging group (2.6 % vs. 2.1 %, p=0.59). There were no cardiac deaths in the exercise-only group. At 1 year there was no difference in the number of repeat functional stress tests (1.6 % vs. 2.1 %, p=0.43), fewer angiograms (0 % vs. 4.0 %, p=0.002), and a significantly lower cost ($65 +/-$332 vs $506 +/-$1,991, p=0.002; values are in US dollars) in the exercise-only group. The radiation exposure in the exercise plus imaging group was 8.4 +/- 2.1 mSv.Conclusions A provisional injection protocol has a very low mortality, few follow-up diagnostic tests, and lower cost compared to standard imaging protocols. If adopted it would decrease radiation exposure, save time and decrease health-care costs without jeopardizing prognosis.