Sharir T, Bacher-Stier C, Dhar S, Lewin H C, Miranda R, Friedman J D, Germano G, Berman D S
Department of Imaging, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, California 90048, USA.
Am J Cardiol. 2000 Dec 1;86(11):1171-5. doi: 10.1016/s0002-9149(00)01206-6.
Postexercise wall motion abnormality (WMA) in patients with normal resting myocardial perfusion may represent prolonged postischemic stunning, and may be related to the presence of severe angiographic coronary artery disease (CAD). This study assesses the diagnostic value of postexercise WMA by technetium-99m (Tc-99m) sestamibi gated single-photon emission computed tomography (SPECT) in patients with normal resting perfusion. Ninety-nine patients underwent exercise gated Tc-99m sestamibi/resting thallium-201 SPECT and coronary angiography within 90 days of nuclear testing. All patients had normal perfusion at rest. Multivariate logistic regression analysis demonstrated an incremental value of wall motion and perfusion over perfusion data alone in identifying severe and extensive CAD. Sensitivity for identifying any severely stenosed coronary artery by WMA was significantly higher than by severe perfusion defect (78% vs 49%, p <0.0001). Overall specificities of severe perfusion defect and WMA were 91% and 85%, respectively (p = NS). Thus, postexercise WMA detected by gated Tc-99m sestamibi SPECT in patients with normal resting perfusion is a sensitive marker of severe and extensive CAD.
静息心肌灌注正常的患者运动后室壁运动异常（WMA）可能代表缺血后心肌顿抑持续存在，且可能与严重的冠状动脉造影显示的冠状动脉疾病（CAD）有关。本研究评估了锝-99m（Tc-99m）甲氧基异丁基异腈门控单光子发射计算机断层扫描（SPECT）检测运动后WMA对静息灌注正常患者的诊断价值。99例患者在核素检查后90天内接受了运动门控Tc-99m甲氧基异丁基异腈/静息铊-201 SPECT及冠状动脉造影检查。所有患者静息时灌注均正常。多因素逻辑回归分析表明，在识别严重和广泛CAD方面，室壁运动和灌注较单纯灌注数据具有增量价值。通过WMA识别任何严重狭窄冠状动脉的敏感性显著高于严重灌注缺损（78%对49%，p<0.0001）。严重灌注缺损和WMA的总体特异性分别为91%和85%（p=无显著差异）。因此，门控Tc-99m甲氧基异丁基异腈SPECT检测到的静息灌注正常患者运动后WMA是严重和广泛CAD的敏感标志物。
