多巴酚丁胺 - 阿托品负荷超声心动图和双嘧达莫 - 司他米比心肌显像用于检测冠状动脉疾病：局限性与一致性

Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: limitations and concordance.

作者信息

Smart S C, Bhatia A, Hellman R, Stoiber T, Krasnow A, Collier B D, Sagar K B

机构信息

Division of Cardiology, Gundersen Lutheran, University of Wisconsin, La Crosse 54601, USA.

出版信息

J Am Coll Cardiol. 2000 Oct;36(4):1265-73. doi: 10.1016/s0735-1097(00)00825-1.

DOI:10.1016/s0735-1097(00)00825-1

PMID:11028482

Abstract

OBJECTIVES

We sought to compare dobutamine-atropine stress echocardiography (DASE) and dipyridamole Technetium 99-m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) scintigraphy (DMIBI) for detecting coronary artery disease (CAD).

BACKGROUND

Both DASE and DMIBI are effective for evaluating patients for CAD, but their concordance and limitations have not been directly compared.

METHODS

To investigate these aims, patients underwent multistage DASE, DMIBI and coronary angiography within three months. Dobutamine-atropine stress echocardiography and stress-rest DMIBI were performed according to standard techniques and analyzed for their accuracy in predicting the extent of CAD. Segments were assigned to vascular territories according to standard models. Angiography was performed using the Judkin's technique.

RESULTS

The 183 patients (mean age: 60 +/- 11 years, including 50 women) consisted of 64 patients with no coronary disease and 61 with single-, 40 with two- and 18 with three-vessel coronary disease. Dobutamine-atropine stress echocardiography and DMIBI were similarly sensitive (87%, 104/119 and 80%, 95/119, respectively) for the detection of CAD, but DASE was more specific (91%, 58/64 vs. 73%, 47/64, p < 0.01). Sensitivity was similar for the detection of CAD in patients with single-vessel disease (84%, 51/61 vs. 74%, 45/61, respectively) and multivessel disease (91%, 53/58 vs. 86%, 50/58, respectively). Multiple wall motion abnormalities and perfusion defects were similarly sensitive for multivessel disease (72%, 42/58 vs. 66%, 38/53, respectively), but, again, DASE was more specific than DMIBI (95%, 119/125 vs. 76%, 95/125, respectively, p < 0.01). Dobutamine-atropine stress echocardiography and DMIBI were moderately concordant for the detection and extent of CAD (Kappa 0.47, p < 0.0001) but were only fairly (Kappa 0.35, p < 0.001) concordant for the type of abnormalities (normal, fixed, ischemia or mixed).

CONCLUSIONS

Dobutamine-atropine stress echocardiography and DMIBI were comparable tests for the detection of CAD. Both were very sensitive for the detection of CAD and moderately sensitive for the extent of disease. The only advantage of DASE was greater specificity, especially for multivessel disease. Dobutamine-atropine stress echocardiography may be advantageous in patients with lower probabilities of CAD.

摘要

目的

我们旨在比较多巴酚丁胺 - 阿托品负荷超声心动图（DASE）和双嘧达莫锝99m（Tc - 99m）甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）心肌灌注显像（DMIBI）检测冠状动脉疾病（CAD）的效果。

背景

DASE和DMIBI在评估CAD患者方面均有效，但它们的一致性和局限性尚未直接比较。

方法

为研究这些目标，患者在三个月内接受了多阶段的DASE、DMIBI和冠状动脉造影检查。多巴酚丁胺 - 阿托品负荷超声心动图和负荷 - 静息DMIBI按照标准技术进行操作，并分析它们预测CAD范围的准确性。根据标准模型将节段分配到血管区域。冠状动脉造影采用Judkin技术。

结果

183例患者（平均年龄：60±11岁，包括50名女性），其中64例无冠状动脉疾病，61例单支血管病变，40例两支血管病变，18例三支血管病变。多巴酚丁胺 - 阿托品负荷超声心动图和DMIBI检测CAD的敏感性相似（分别为87%，104/119和80%，95/119），但DASE的特异性更高（分别为91%，58/64和73%，47/64，p<0.01）。单支血管病变患者（分别为84%，51/61和74%，45/61）和多支血管病变患者（分别为91%，53/58和86%，50/58）中，检测CAD的敏感性相似。多支血管病变时，多个室壁运动异常和灌注缺损的敏感性相似（分别为72%，42/58和66%，38/53），但同样，DASE比DMIBI更具特异性（分别为95%，119/125和76%，95/125，p<0.01）。多巴酚丁胺 - 阿托品负荷超声心动图和DMIBI在检测CAD及其范围方面具有中度一致性（Kappa值为0.47，p<0.0001），但在异常类型（正常、固定、缺血或混合）方面仅具有中等程度的一致性（Kappa值为0.35，p<0.001）。