Pace L, Filardi P P, Cuocolo A, Prastaro M, Acampa W, Dellegrottaglie S, Storto G, Della Morte A M, Piscione F, Chiariello M, Salvatore M
Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli, Italy.
Eur J Nucl Med. 2001 Nov;28(11):1616-23. doi: 10.1007/s002590100608.
It is known that contractile reserve may be blunted if perfusion and coronary flow reserve are reduced. Thus, it is conceivable that the predictive accuracy of dobutamine echocardiography may differ according to perfusion tracer uptake. The aim of this study was therefore to assess the relationship between the level of thallium-201 uptake and the accuracy of dobutamine echocardiography in identifying reversible dysfunction. Sixty-nine patients (age 59+/-8 years, ejection fraction 40%+/-11%) with chronic coronary artery disease scheduled for coronary revascularisation were studied. All patients underwent rest 201Tl single-photon emission tomography and two-dimensional echocardiography at rest and during low-dose dobutamine infusion on the same day before revascularisation and repeated echocardiography at least 30 days thereafter. At follow-up, recovery of function was observed in 49% of 339 dysfunctional segments. The percentage of segments with post-revascularisation recovery of function and the percentage with contractile reserve increased in parallel with 201Tl uptake both in the total group of segments (chi2=35.5, P<0.0001 and chi2=35.9, P<0.0001, respectively) and among the 183 akinetic segments (chi2=44.4, P<0.0001 and chi2=14.6, P<0.05, respectively). The dysfunctional segments were divided into three groups according to 201Tl uptake: (a) uptake <65%, (b) uptake between 65% and 79%, (c) uptake >80%. The positive predictive value increased significantly with the level of 201Tl uptake, and was suboptimal (46%) in akinetic segments with severely reduced 201Tl uptake. The negative predictive value decreased significantly with 201Tl uptake, and it was less than suboptimal (29%) in akinetic segments with normal tracer uptake. Sensitivity was lower in the subset of akinetic segments (42%-63%) than in all dyssynergic segments (63%-76%), whereas specificity was very high in akinetic segments (80%-84%). It is concluded that the accuracy of low-dose dobutamine echocardiography in predicting reversibility of regional dysfunction varies considerably according to 201Tl uptake at rest and to the severity of regional dysfunction.
已知如果灌注和冠状动脉血流储备降低，收缩储备可能会减弱。因此，可以想象，多巴酚丁胺超声心动图的预测准确性可能会因灌注示踪剂摄取情况而有所不同。因此，本研究的目的是评估201铊摄取水平与多巴酚丁胺超声心动图识别可逆性功能障碍准确性之间的关系。对69例计划进行冠状动脉血运重建的慢性冠状动脉疾病患者（年龄59±8岁，射血分数40%±11%）进行了研究。所有患者在血运重建前同一天进行静息状态下的201铊单光子发射断层扫描以及静息和低剂量多巴酚丁胺输注期间的二维超声心动图检查，并在至少30天后重复进行超声心动图检查。随访时，在339个功能障碍节段中有49%观察到功能恢复。在总的节段组中（分别为χ2=35.5，P<0.0001和χ2=35.9，P<0.0001）以及在183个运动不能节段中（分别为χ2=44.4，P<0.0001和χ2=14.6，P<0.05），血运重建后功能恢复节段的百分比和具有收缩储备节段的百分比均与201铊摄取呈平行增加。根据201铊摄取情况将功能障碍节段分为三组：（a）摄取<65%，（b）摄取在65%至79%之间，（c）摄取>80%。阳性预测值随201铊摄取水平显著增加，在201铊摄取严重降低的运动不能节段中为次优（46%）。阴性预测值随201铊摄取显著降低，在示踪剂摄取正常的运动不能节段中低于次优（29%）。运动不能节段亚组的敏感性（42%-63%）低于所有协同失调节段（63%-76%），而运动不能节段的特异性非常高（80%-84%）。结论是，低剂量多巴酚丁胺超声心动图预测局部功能障碍可逆性的准确性根据静息时的201铊摄取以及局部功能障碍的严重程度有很大差异。
