Fragasso G, Lu C, Dabrowski P, Pagnotta P, Sheiban I, Chierchia S L
Divisione di Cardiologia, Istituto Scientifico H San Raffaele, Milan, Italy.
J Am Coll Cardiol. 1999 Aug;34(2):441-7. doi: 10.1016/s0735-1097(99)00231-4.
Although different noninvasive tests have been proposed for detecting coronary artery disease (CAD) in patients with hypertension and chest pain symptoms, the relative performance of the available techniques has not been systematically assessed.
Patients with hypertension frequently complain of chest pain and exhibit ischemic-like ST segment changes on the exercise electrocardiogram (ECG). However, the specificity of such changes for predicting significant CAD is very low, because these patients often exhibit a normal coronary angiogram.
In 101 patients with hypertension, chest pain and positive exercise ECG, we performed stress/rest myocardial single photon emission computed tomography with 99mTc-MIBI, dipyridamole and dobutamine stress echocardiography and coronary angiography. All patients had normal global ventricular function and 57 had left ventricular hypertrophy. All were kept on ACE inhibitors during the study period.
No patients had significant side effects during perfusion scintigraphy. Dose-limiting side effects were observed in five patients with dipyridamole and in seven patients with dobutamine. Only 56% of study patients exhibited significant CAD. Sensitivity, specificity, accuracy, positive and negative predictive values were, respectively, 98%, 36%, 71%, 67% and 94% for perfusion scintigraphy, 61%, 91%, 74%, 90% and 64% for dipyridamole and 88%, 80%, 84%, 85% and 83% for dobutamine stress echocardiography.
This study shows that stress echo in patients with hypertension yields a satisfactory diagnostic accuracy for identifying significant epicardial CAD. Our results indicate that dobutamine might be superior to dipyridamole. The low specificity of myocardial scintigraphy probably relates to the fact that this method traces perfusion abnormalities, not necessarily caused by epicardial CAD, possibly due to microvascular disease and not causing obvious wall motion abnormalities.
尽管已提出不同的非侵入性检查用于检测高血压和胸痛症状患者的冠状动脉疾病（CAD），但尚未对现有技术的相对性能进行系统评估。
高血压患者经常诉说胸痛，且运动心电图（ECG）显示缺血样ST段改变。然而，此类改变预测显著CAD的特异性非常低，因为这些患者冠状动脉造影常显示正常。
对101例有高血压、胸痛且运动心电图阳性的患者，我们进行了99mTc - MIBI负荷/静息心肌单光子发射计算机断层扫描、双嘧达莫和多巴酚丁胺负荷超声心动图以及冠状动脉造影。所有患者整体心室功能正常，57例有左心室肥厚。研究期间所有患者均持续使用血管紧张素转换酶抑制剂。
灌注闪烁扫描期间无患者出现明显副作用。双嘧达莫组有5例患者、多巴酚丁胺组有7例患者出现剂量限制性副作用。仅56%的研究患者显示有显著CAD。灌注闪烁扫描的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98%、36%、71%、67%和94%；双嘧达莫为61%、91%、74%、90%和64%；多巴酚丁胺负荷超声心动图为88%、80%、84%、85%和83%。
本研究表明，高血压患者的负荷超声心动图在识别显著的心外膜CAD方面具有令人满意的诊断准确性。我们的结果表明多巴酚丁胺可能优于双嘧达莫。心肌闪烁扫描的低特异性可能与该方法追踪的灌注异常不一定由心外膜CAD引起这一事实有关，可能是由于微血管疾病且未导致明显的室壁运动异常。
