Azzarelli S, Galassi A R, Foti R, Mammana C, Musumeci S, Giuffrida G, Tamburino C
Institute of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
J Nucl Cardiol. 1999 Mar-Apr;6(2):183-9. doi: 10.1016/s1071-3581(99)90079-x.
Technetium 99m-labeled myocardial agents have been proposed as an alternative to thallium 201. The aim of this study was to assess retrospectively the accuracy of exercise myocardial 99mTc-tetrofosmin scintigraphy with tomographic imaging (SPECT) in a large group population in the evaluation of coronary artery disease. Furthermore we evaluated the relation between the severity of scintigraphic impaired myocardial perfusion and the angiographic coronary artery stenoses in patients without myocardial infarction and with stenosis localized exclusively in the proximal segment of the 3 main coronary arteries.
The study group consisted of 235 consecutive patients, 204 (87%) of whom were men, with a mean age of 57+/-10 years, and with suspected or known coronary artery disease, who underwent 99mTc-tetrofosmin SPECT and coronary angiography. Furthermore, 61 patients in a low-likelihood group for coronary artery disease were also studied. Significant disease was defined by > or = 50% luminal coronary artery stenosis in > or = 1 native coronary artery or major branch or in a saphenous vein graft or arterial mammary graft. The overall sensitivity was 95%, specificity was 76%, and predictive accuracy was 95%. The normalcy rate for the low-likelihood group was 93%. Sensitivity was 71% for the left anterior descending artery, 61% for the left circumflex artery, and 73% for the right coronary artery. Specificity was 94% for the left anterior descending artery, 96% for the left circumflex artery, and 91% for the right coronary artery. Predictive accuracy was 79% for the left anterior descending artery, 78% for the left circumflex artery, and 81 % for the right coronary artery. In patients without myocardial infarction linear regression analysis between scintigraphy and angiography showed a significant correlation in patients with severe proximal coronary artery stenosis (r = 0.53, P < .002), but not in those with moderate proximal stenosis (r = 0.31, P = NS).
This study shows that 99mTc-tetrofosmin SPECT is accurate in the detection of coronary artery disease. The relation of the severity of scintigraphic impaired myocardial perfusion and angiographic coronary artery stenosis, however, may differ significantly in patients with proximal stenosis of different severity.
锝99m标记的心肌显像剂已被提议作为铊201的替代物。本研究的目的是回顾性评估在一大群人群中，运动心肌99mTc - 替曲膦断层显像（SPECT）在评估冠状动脉疾病方面的准确性。此外，我们还评估了在无心肌梗死且狭窄仅局限于3条主要冠状动脉近端节段的患者中，心肌灌注显像受损的严重程度与冠状动脉造影狭窄之间的关系。
研究组由235例连续患者组成，其中204例（87%）为男性，平均年龄57±10岁，怀疑或已知患有冠状动脉疾病，他们接受了99mTc - 替曲膦SPECT和冠状动脉造影检查。此外，还对61例冠状动脉疾病可能性较低的患者进行了研究。显著病变定义为在≥1条自身冠状动脉或主要分支、或大隐静脉移植物或动脉乳内动脉移植物中，冠状动脉管腔狭窄≥50%。总体敏感性为95%，特异性为76%，预测准确性为95%。低可能性组的正常率为93%。左前降支的敏感性为71%，左旋支为61%，右冠状动脉为73%。左前降支的特异性为94%，左旋支为96%，右冠状动脉为91%。左前降支的预测准确性为79%，左旋支为78%，右冠状动脉为81%。在无心肌梗死的患者中，显像与造影之间的线性回归分析显示，在严重冠状动脉近端狭窄患者中存在显著相关性（r = 0.53，P <.002），但在中度近端狭窄患者中无显著相关性（r = 0.31，P = 无显著性差异）。
本研究表明，99mTc - 替曲膦SPECT在检测冠状动脉疾病方面是准确的。然而，在不同严重程度的近端狭窄患者中，心肌灌注显像受损的严重程度与冠状动脉造影狭窄之间的关系可能有显著差异。
