急性心肌梗死后的心肌存活评估：小剂量多巴酚丁胺超声心动图与静息-再分布铊-201单光子发射计算机断层扫描的比较

Myocardial viability assessment after acute myocardial infarction: low-dose dobutamine echocardiography versus rest-redistribution thallium-201 SPECT.

作者信息

Castini D, Bestetti A, Garbin M, Di Leo C, Bigi R, Sponzilli C, Concardi G, Gioventù M, Tarolo G L, Lombardi F, Fiorentini C

机构信息

Divisione di Cardiologia, Università degli Studi, Ospedale San Paolo, Milano.

出版信息

Cardiologia. 1999 Sep;44(9):817-23.

PMID:10609391

Abstract

BACKGROUND

The presence of tissue viability is of great importance in the prognostic work-up of patients recovering from acute myocardial infarction. However, uncertainty still exists concerning the optimal tool for its assessment. The present study was undertaken in order to compare low-dose dobutamine echocardiography and rest-redistribution thallium SPECT for predicting late improvement of regional left ventricular function after acute myocardial infarction.

METHODS

Fifteen patients undergoing coronary angiography, low-dose dobutamine echocardiography and rest-redistribution thallium SPECT after thrombolyzed anterior acute myocardial infarction were studied. A 3 month follow-up echocardiogram was performed in all patients and 9 underwent coronary revascularization.

RESULTS

A significant (> or = 70%) residual stenosis of the infarct-related artery was present in 14 patients, whilst a total occlusion was observed in 1. At 3 month follow-up, 41% of the dyssynergic segments improved. The sensitivity, specificity and accuracy for late wall motion improvement was 61, 89 and 77% for low-dose dobutamine echocardiography and, respectively, 76, 45 and 58% for rest-redistribution thallium SPECT. Tissue viability was detected in 65 and 31% of dyssynergic segments by rest-redistribution thallium SPECT and low-dose dobutamine echocardiography, respectively (p < 0.001). The agreement between the two techniques was 48%.

CONCLUSIONS

Low-dose dobutamine echocardiography is more accurate than rest-redistribution thallium SPECT for predicting 3 month wall motion improvement in patients with acute anterior myocardial infarction, mainly due to its significantly better specificity.

摘要

背景

组织存活能力的存在对急性心肌梗死恢复患者的预后评估极为重要。然而，关于评估其的最佳工具仍存在不确定性。本研究旨在比较低剂量多巴酚丁胺超声心动图和静息-再分布铊单光子发射计算机断层扫描（SPECT）对预测急性心肌梗死后左心室局部功能的晚期改善情况。

方法

对15例溶栓治疗后前壁急性心肌梗死患者进行冠状动脉造影、低剂量多巴酚丁胺超声心动图和静息-再分布铊SPECT检查。所有患者均进行了3个月的随访超声心动图检查，其中9例接受了冠状动脉血运重建。

结果

14例患者梗死相关动脉存在显著（≥70%）残余狭窄，1例观察到完全闭塞。在3个月随访时，41%的运动失调节段有所改善。低剂量多巴酚丁胺超声心动图对晚期室壁运动改善的敏感性、特异性和准确性分别为61%、89%和77%，静息-再分布铊SPECT分别为76%、45%和58%。静息-再分布铊SPECT和低剂量多巴酚丁胺超声心动图分别在65%和31%的运动失调节段检测到组织存活能力（p<0.001）。两种技术之间的一致性为48%。