Rambaldi R, Poldermans D, Bax J J, Boersma E, Valkema R, Elhendy A, Vletter W B, Fioretti P M, Roelandt J R, Krenning E P
Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 1999 Jul 15;84(2):130-4. doi: 10.1016/s0002-9149(99)00221-0.
The purpose of this study was to compare 2 different techniques--dobutamine-atropine stress echocardiography (DSE) and dual-isotope simultaneous acquisition (technetium-99-m-tetrofosmin/fluorine 18-fluorodeoxyglucose) single-photon emission computed tomography (DISA-SPECT)--for assessment of viable myocardium. One hundred ten patients (mean age 55 +/- 9 years) with left ventricular (LV) dysfunction (mean LV ejection fraction 27 +/- 13%) underwent both DISA-SPECT and DSE. A 16-segment scoring model was adopted for both techniques. Four types of wall motion during DSE were assessed: (1) biphasic, improvement at low dose (10 microg/kg/min) with worsening at high dose; (2) worsening, deterioration without initial improvement; (3) sustained, persistent or late improvement; and (4) no change. Viability criteria were biphasic, worsening, and sustained improvement with DSE. Viability criteria with DISA-SPECT were normal perfusion and metabolism (normal), concordantly mildly reduced perfusion and metabolism (subendocardial scar), or severely reduced perfusion and increased metabolism (mismatch). Myocardium was considered nonviable with DSE in case of unchanged wall motion, or moderate reduction or absence in both technetium-99m-tetrofosmin perfusion and fluorodeoxyglucose uptake with DISA-SPECT. Of 1,756 of 1,760 analyzable LV segments, 1,373 (78%) had severe wall motion abnormalities at baseline (severe hypokinesia, akinesia, or dyskinesia). Of these abnormal segments, 282 (21%) were considered viable during DSE (63 [5%] with biphasic response, 47 [3%] with ischemia, and 172 [13%]) with sustained improvement, whereas 1,091 (79%) were considered nonviable. With DISA-SPECT, 396 (29%) segments were considered viable (312 [23%] with matched perfusion/metabolism and 84 [6%] with mismatch), whereas 977 segments (71%) were considered nonviable. Both techniques showed agreement for viability in 201 segments and 896 were concordantly classified as nonviable. Disagreement was present in 276 segments of which 195 (71%) were nonviable with DSE and viable with DISA-SPECT. Overall agreement between the 2 techniques was 81% (kappa 0.46) in a subgroup of patients with an ejection fraction <25% 78% (kappa 0.39). Thus, DSE and DISA-SPECT show good agreement for assessing viable myocardium not influenced by resting ejection fraction. DSE underestimated the amount of viable tissue compared with DISA-SPECT.
本研究的目的是比较两种不同技术——多巴酚丁胺 - 阿托品负荷超声心动图（DSE）和双同位素同时采集（锝 - 99m - 替曲膦/氟 - 18 - 氟脱氧葡萄糖）单光子发射计算机断层扫描（DISA - SPECT）——用于评估存活心肌。110例左心室（LV）功能障碍（平均LV射血分数27±13%）患者（平均年龄55±9岁）接受了DISA - SPECT和DSE检查。两种技术均采用16节段评分模型。评估了DSE期间的四种壁运动类型：（1）双相型，低剂量（10μg/kg/min）时改善，高剂量时恶化；（2）恶化型，无初始改善而恶化；（3）持续型，持续或晚期改善；（4）无变化。DSE的存活标准为双相型、恶化型和持续改善型。DISA - SPECT的存活标准为正常灌注和代谢（正常）、灌注和代谢均轻度降低（心内膜下瘢痕）或灌注严重降低和代谢增加（不匹配）。如果壁运动无变化，或DISA - SPECT中锝 - 99m - 替曲膦灌注和氟脱氧葡萄糖摄取中度降低或缺失，则DSE认为心肌无存活能力。在1760个可分析的LV节段中的1756个中，1373个（78%）在基线时有严重壁运动异常（严重运动减弱、运动不能或运动障碍）。在这些异常节段中，282个（21%）在DSE期间被认为有存活能力（63个[5%]有双相反应，47个[3%]有缺血，172个[13%]有持续改善），而1091个（79%）被认为无存活能力。对于DISA - SPECT，396个（29%）节段被认为有存活能力（312个[23%]灌注/代谢匹配，84个[6%]不匹配），而977个节段（71%）被认为无存活能力。两种技术在201个节段中对存活能力的判断一致，896个节段被一致分类为无存活能力。276个节段存在分歧，其中195个（71%）DSE认为无存活能力而DISA - SPECT认为有存活能力。在射血分数<25%的患者亚组中，两种技术的总体一致性为81%（kappa值0.46），一致性为78%（kappa值0.39）。因此，DSE和DISA - SPECT在评估存活心肌方面显示出良好的一致性，不受静息射血分数的影响。与DISA - SPECT相比，DSE低估了存活组织的数量。
