Gibson Peter B, Demus Diane, Noto Richard, Hudson William, Johnson Lynne L
Rhode Island Hospital and Brown University, Providence, Rhode Island 02903, USA.
J Am Coll Cardiol. 2002 Mar 20;39(6):999-1004. doi: 10.1016/s0735-1097(02)01720-5.
We sought to demonstrate the safety of stress-only perfusion imaging among patients with low to medium probability of coronary disease being evaluated for chest pain.
The need for performing rest in addition to stress perfusion imaging to confirm normalcy is due largely to defects created on the stress images by attenuation artifacts. A low cardiac event rate among patients undergoing stress-only imaging with attenuation correction (AC) would validate the safety of stress-only imaging.
Patients with low to medium pretest probability for coronary artery disease (CAD) referred for chest pain evaluation from July 1, 1997 to July 1, 1999, were scheduled for a two-day stress/rest tomographic (single photon emission computerized tomography, or SPECT) perfusion imaging study with Tc-99m sestamibi. Patients were imaged on a variable angle camera with AC using Gd-153 scanning line sources (Vantage ADAC, Milpitas, California). If the stress scan was normal without AC or corrected with AC, the patient did not return for rest scan and was followed.
Seven hundred twenty-nine patients underwent stress-only imaging, and follow-up was obtained on 652 (89%) of those patients. There were 224 males and 428 females with mean age of 52 +/- 13 years. Mean follow-up was 22.3 +/- 6.4 months. The mean pretest probability was 37 +/- 24%. The non-AC images showed breast and/or diaphragmatic attenuation artifacts severe enough to have required the patient to return for rest imaging in 37% of patients, and all corrected completely with AC. During follow-up, there were two noncardiac deaths and no cardiac deaths. There was one myocardial infarction; three patients with progressive unstable angina underwent diagnostic coronary angiography showing significant CAD. The overall cardiac event rate was 0.6%.
These results support stress-only imaging in patients with low to medium probability for CAD as a safe, time- and cost-efficient imaging modality.
我们试图证明，对于因胸痛接受评估、冠心病可能性为低到中度的患者，仅进行负荷灌注成像的安全性。
除负荷灌注成像外还需要进行静息灌注成像以确认正常，这主要是由于衰减伪影在负荷图像上造成的缺损。在接受仅负荷成像并进行衰减校正（AC）的患者中，心脏事件发生率低将证实仅负荷成像的安全性。
1997年7月1日至1999年7月1日因胸痛评估而转诊的、冠心病（CAD）预测试概率为低到中度的患者，计划进行为期两天的负荷/静息断层（单光子发射计算机断层扫描，即SPECT）灌注成像研究，使用锝-99m甲氧基异丁基异腈。患者使用钆-153扫描线源在可变角度相机上进行带有AC的成像（Vantage ADAC，加利福尼亚州米尔皮塔斯）。如果负荷扫描在未进行AC时正常或经AC校正后正常，则患者无需返回进行静息扫描并接受随访。
729例患者接受了仅负荷成像，其中652例（89%）患者获得了随访。有224例男性和428例女性，平均年龄为52±13岁。平均随访时间为22.3±6.4个月。平均预测试概率为37±24%。未进行AC的图像显示，37%的患者存在严重到足以要求患者返回进行静息成像的乳腺和/或膈肌衰减伪影，但所有伪影经AC后完全校正。在随访期间，有2例非心脏性死亡，无心脏性死亡。有1例心肌梗死；3例进行性不稳定型心绞痛患者接受诊断性冠状动脉造影显示有显著CAD。总体心脏事件发生率为0.6%。
这些结果支持，对于CAD可能性为低到中度的患者，仅进行负荷成像作为一种安全、省时且经济高效的成像方式。
