Emmett Louise, Iwanochko Robert M, Freeman Michael R, Barolet Alan, Lee Douglas S, Husain Mansoor
Robert J. Burns Nuclear Cardiology Laboratory, Toronto Western Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2002 Mar 20;39(6):991-8. doi: 10.1016/s0735-1097(02)01707-2.
We sought to determine the level of angiographic stenosis at which reversible regional wall motion abnormalities (RWMA) are present on exercise stress technetium-99m (Tc-99m)- gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and whether assessments of stress and rest RWMA add incremental diagnostic information.
Stress and rest gated SPECT MPI enables the detection of post-exercise stunning. Although some studies have correlated RWMA to the severity of MPI defects, only one previous study correlated RWMA on gated MPI to angiographic findings. However, this correlation excluded patients with rest perfusion defects and did not involve gating of rest images.
One hundred patients undergoing angiography within six months of exercise stress Tc-99m (sestamibi)-gated SPECT MPI (in the absence of interim cardiac events or revascularization) were recruited. Images were acquired 15 to 30 min after stress and interpreted without knowledge of the Duke treadmill score, left ventricular ejection fraction and angiographic data.
The sensitivity of reversible RWMA for angiographic stenoses >70% was 53%, with a specificity of 100%. The presence of reversible RWMA was able to stratify patients with angiographic stenoses of 50% to 79% and 80% to 99% with a high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score (R = 0.49, p < 0.0001). Multivariate analysis showed that the post-stress RWMA, Duke treadmill and reversible RWMA scores were significant predictors of angiographic severity.
Post-stress and reversible RWMA, as shown by exercise stress Tc-99m-gated SPECT MPI, are significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity.
我们试图确定在运动负荷锝-99m（Tc-99m）门控单光子发射计算机断层扫描（SPECT）心肌灌注显像（MPI）时出现可逆性局部室壁运动异常（RWMA）的血管造影狭窄程度，以及负荷和静息RWMA评估是否能增加诊断信息。
负荷和静息门控SPECT MPI能够检测运动后心肌顿抑。虽然一些研究已将RWMA与MPI缺损的严重程度相关联，但之前仅有一项研究将门控MPI上的RWMA与血管造影结果相关联。然而，这种相关性排除了有静息灌注缺损的患者，且未涉及静息图像的门控。
招募了100例在运动负荷Tc-99m（ sestamibi）门控SPECT MPI后6个月内接受血管造影的患者（无期间心脏事件或血运重建）。在负荷后15至30分钟采集图像，并在不了解杜克运动平板评分、左心室射血分数和血管造影数据的情况下进行解读。
可逆性RWMA对血管造影狭窄>70%的敏感性为53%，特异性为100%。可逆性RWMA的存在能够以较高的阳性预测值对血管造影狭窄为50%至79%和80%至99%的患者进行分层。可逆性RWMA的存在与冠状动脉危险评分之间存在良好的相关性（R = 0.49，p < 0.0001）。多变量分析显示，负荷后RWMA、杜克运动平板和可逆性RWMA评分是血管造影严重程度的显著预测因素。
运动负荷Tc-99m门控SPECT MPI显示的负荷后和可逆性RWMA是血管造影疾病的显著预测因素，并为MPI评估血管造影严重程度增加了额外价值。
