Yamazaki Y, Imai K, Konaka R, Nakajima T, Goto S, Horie T, Saito S, Ozawa Y, Kanmatsuse K
Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Itai 1696, Konan-machi, Ohsato-gun, Saitama 360-0105.
J Cardiol. 2001 Sep;38(3):123-35.
Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography(ECG) gated single photon emission computed tomography(SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease.
ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease(1VD), 28 with two-vessel disease(2VD), and 18 with three-vessel disease(3VD). The group with zero-vessel disease(0VD) consisted of 50 patients. According to post-stress and rest ejection fraction(EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF--post-stress EF > or = 5% and post-stress ESV--rest ESV > or = 5 ml.
In the coronary artery disease group, post-stress ESV was larger than rest ESV(37.8 +/- 26.4, 34.0 +/- 24.2 ml, p < 0.001), and post-stress EF was lower than rest EF (61.5 +/- 11.1%, 64.2 +/- 10.8%, p < 0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7 +/- 20.8, 26.2 +/- 21.6 ml, NS; 70.4 +/- 9.5%, 70.0 +/- 9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group(p < 0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD(38.9%) groups was higher than that in the 0VD group(p < 0.01, p < 0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82%(p < 0.05), but reduced the specificity from 92% to 86%(p = 0.08).
Post-stress dysfunction is a useful parameter for clinical diagnosis of coronary artery disease.
心肌灌注成像对三支血管病变患者冠状动脉疾病的诊断敏感性较低。通过心电图（ECG）门控单光子发射计算机断层扫描（SPECT）和定量门控SPECT程序评估冠心病患者应激后左心室功能障碍的存在情况，并探讨将应激后功能障碍与心肌灌注成像相结合是否能改善冠心病的诊断。
对139例患者采用一日法（应激和静息）行ECG门控锝-99m-替曲膦SPECT检查。SPECT检查和冠状动脉造影在1个月内完成。冠心病组包括89例患者：单支血管病变（1VD）43例，双支血管病变（2VD）28例，三支血管病变（3VD）18例。零支血管病变（0VD）组包括50例患者。根据应激后和静息时的射血分数（EF）及收缩末期容积（ESV），应激后功能障碍定义如下：静息EF - 应激后EF≥5%且应激后ESV - 静息ESV≥5 ml。
在冠心病组中，应激后ESV大于静息ESV（37.8±26.4，34.0±24.2 ml，p<0.001），应激后EF低于静息EF（61.5±11.1%，64.2±10.8%，p<0.001）。在0VD组中，应激后和静息时的ESV及EF相同（25.7±20.8，26.2±21.6 ml，无显著性差异；70.4±9.5%，70.0±9.6%，无显著性差异）。0VD组应激后功能障碍为6.0%，冠心病组为30.3%（p<0.001）。此外，2VD组（35.7%）和3VD组（38.9%）的应激后功能障碍高于0VD组（p<0.01，p<0.01）。心肌灌注成像诊断冠心病的敏感性为75%。应激后功能障碍与心肌灌注成像相结合使敏感性从75%提高到82%（p<0.05），但特异性从92%降至86%（p = 0.08）。
应激后功能障碍是冠心病临床诊断的一个有用参数。
