Elhendy A, Sozzi F B, Valkema R, van Domburg R T, Bax J J, Roelandt J R
Thorax Center and the Department of Nuclear Medicine, University Hospital Rotterdam, The Netherlands.
J Nucl Cardiol. 2000 Nov-Dec;7(6):649-54. doi: 10.1067/mnc.2000.109660.
Technetium-99m tetrofosmin single photon emission computed tomography (SPECT) imaging is increasingly used in conjunction with exercise and vasodilator stress test as a means of evaluating coronary artery disease (CAD). Dobutamine stress test is an alternative in patients with limited exercise capacity. This study assessed the accuracy of dobutamine-atropine stress tetrofosmin SPECT as a means of diagnosing and localizing CAD.
We studied 124 patients (mean age, 57+/-12 years; 88 men) with limited exercise capacity and suspected CAD with dobutamine (as much as 40 microg/kg/min)-atropine (as much as 1 mg) Tc-99m tetrofosmin SPECT. Resting images were acquired 24 hours after the stress test. Significant CAD was defined as 50% or greater luminal diameter stenosis in 1 or more major coronary arteries. Myocardial perfusion abnormalities (fixed and/or reversible defects) were detected in 70 of 88 patients with CAD and in 10 of the 36 patients without CAD (sensitivity = 80%, CI, 72 to 87; specificity = 72%, CI, 64 to 80; accuracy = 77%, CI, 70 to 85). Sensitivity and accuracy rates were higher by using the criterion of any defect than by using the criterion of reversible defects only (80% vs 51%, P<.0001; 77% vs 60%, P<.01, respectively). The sensitivity rate was higher in patients with multivessel CAD than in patients with single-vessel CAD (88% vs 63%, P<.05). Patients with multivessel CAD had a larger stress perfusion defect score (4.5+/-3.1 vs. 2.7+/-2.5, P<.01) than patients with single-vessel CAD.
Dobutamine stress Tc-99m tetrofosmin SPECT is a useful method for the diagnosis and localization of CAD in patients with limited exercise capacity. Optimal accuracy of the technique is achieved by using both fixed and reversible perfusion abnormalities for the diagnosis of CAD in patients without an earlier myocardial infarction.
锝-99m替曲膦单光子发射计算机断层扫描（SPECT）成像越来越多地与运动及血管扩张剂负荷试验联合使用，作为评估冠状动脉疾病（CAD）的一种手段。多巴酚丁胺负荷试验是运动能力受限患者的一种替代方法。本研究评估了多巴酚丁胺-阿托品负荷替曲膦SPECT诊断和定位CAD的准确性。
我们研究了124例运动能力受限且疑似CAD的患者（平均年龄57±12岁；88例男性），采用多巴酚丁胺（最大剂量40μg/kg/min）-阿托品（最大剂量1mg）锝-99m替曲膦SPECT检查。静息图像在负荷试验后24小时采集。显著CAD定义为1条或更多主要冠状动脉管腔直径狭窄50%或更严重。在88例CAD患者中有70例检测到心肌灌注异常（固定和/或可逆性缺损），在36例无CAD患者中有10例检测到（敏感性=80%，可信区间72%至87%；特异性=72%，可信区间64%至80%；准确性=77%，可信区间70%至85%）。使用任何缺损标准的敏感性和准确率均高于仅使用可逆性缺损标准（分别为80%对51%，P<0.0001；77%对60%，P<0.01）。多支血管CAD患者的敏感性高于单支血管CAD患者（88%对63%，P<0.05）。多支血管CAD患者的负荷灌注缺损评分（4.5±3.1对2.7±2.5，P<0.01）高于单支血管CAD患者。
多巴酚丁胺负荷锝-99m替曲膦SPECT是诊断和定位运动能力受限患者CAD的一种有用方法。对于无早期心肌梗死的患者，通过使用固定和可逆性灌注异常来诊断CAD可实现该技术的最佳准确性。
