Elhendy Abdou, Schinkel Arend F L, van Domburg Ron T, Bax Jeroen J, Poldermans Don
University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
Am J Cardiol. 2003 Feb 1;91(3):264-8. doi: 10.1016/s0002-9149(02)03152-1.
The aim of this study was to assess the prognostic significance of reversible perfusion abnormalities in patients without angina during dobutamine stress technetium-99m sestamibi single-photon emission computed tomography (SPECT). The study comprised 224 patients (age 60 +/- 11 years, 144 men) with completely or partially reversible perfusion abnormalities during dobutamine stress sestamibi SPECT. Follow-up end points were hard cardiac events (cardiac death and nonfatal myocardial infarction). Angina occurred in 93 patients (42%) during the dobutamine stress test (symptomatic ischemia group). The 131 patients without dobutamine-induced angina represented the silent ischemia group. There was no significant difference between patients with and without angina with regard to summed stress perfusion score (5.3 +/- 2.5 vs 5.2 +/- 2.2, p = 0.9) or summed ischemic score (3.1 +/- 1.7 vs 3.2 +/- 1.4, p = 0.7). During a median follow-up of 7.2 years, cardiac death occurred in 14 patients (15%) with and in 21 patients (16%) without angina. Nonfatal myocardial infarction occurred in 8 patients (9%) with and in 13 patients (10%) without angina. In a multivariate analysis model of clinical and perfusion data, independent predictors of cardiac events were age (hazard ratio 1.02, confidence intervals [CI] 1.01 to 1.05 per year increment), diabetes mellitus (hazard ratio 1.9, CI 1.2 to 3.4), and ischemic perfusion score (hazard ratio 2.1, CI 1.3 to 3.8). Patients with silent ischemia defined as reversible perfusion abnormalities without associated angina during dobutamine stress sestamibi SPECT imaging had similar incidences of ischemia and similar cardiac event rates compared with patients with symptomatic ischemia. Therefore, the absence of angina in association with reversible perfusion abnormalities should not be interpreted as a sign of a more benign prognosis.
本研究旨在评估在多巴酚丁胺负荷99m锝甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）期间无胸痛患者可逆性灌注异常的预后意义。该研究纳入了224例患者（年龄60±11岁，男性144例），这些患者在多巴酚丁胺负荷甲氧基异丁基异腈SPECT检查时有完全或部分可逆性灌注异常。随访终点为严重心脏事件（心源性死亡和非致命性心肌梗死）。93例患者（42%）在多巴酚丁胺负荷试验期间出现胸痛（症状性缺血组）。131例无多巴酚丁胺诱发胸痛的患者代表无症状性缺血组。有胸痛和无胸痛患者之间在总负荷灌注评分（5.3±2.5对5.2±2.2，p = 0.9）或总缺血评分（3.1±1.7对3.2±1.4，p = 0.7）方面无显著差异。在中位随访7.2年期间，有胸痛的14例患者（15%）和无胸痛的21例患者（16%）发生心源性死亡。有胸痛的8例患者（9%）和无胸痛的13例患者（10%）发生非致命性心肌梗死。在临床和灌注数据的多变量分析模型中，心脏事件的独立预测因素为年龄（风险比1.02，置信区间[CI]为每年增加1.01至1.05）、糖尿病（风险比1.9，CI为1.2至3.4）和缺血灌注评分（风险比2.1，CI为1.3至3.8）。与症状性缺血患者相比，在多巴酚丁胺负荷甲氧基异丁基异腈SPECT成像期间定义为无胸痛且伴有可逆性灌注异常的无症状性缺血患者，其缺血发生率和心脏事件发生率相似。因此，与可逆性灌注异常相关的无胸痛不应被解释为预后更良好的迹象。
