Dinckal M Hakan, Aksoy Nur, Aksoy Mehmet, Davutoglu Vedat, Dinckal Nurten, Soydinc Serdar, Akdemir Ilyas
Department of Cardiology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
Int J Cardiovasc Imaging. 2003 Dec;19(6):511-7. doi: 10.1023/b:caim.0000004346.60326.bc.
Troponin T (TnT) and rest perfusion imaging (RPI) have been reported to be important diagnostic tools for risk stratification in patients with chest pain.
We investigated the association between two methods in 60 patients presenting with typical chest pain at rest within the last 6 h before admission. All patients underwent Tc-99m gated SPECT imaging and serial TnT measurements and were followed for occurrence of adverse cardiac events up to 30 days.
Perfusion defect was detected in 42 patients and elevated TnT was observed in 23 patients. All of the patients with an elevated TnT have also perfusion defect in RPI. Half of the patients with normal TnT level (51%) presented a perfusion defect detected by RPI (p = NS). The patients with elevated TnT levels had more perfusion defect numbers than those with normal TnT levels (8.2 +/- 2.9 vs. 5.3 +/- 2.2; p = 0.0007). Cardiac events occurred in 38 patients (14 MI, 24 revascularisation). In predicting cardiac events, RPI and TnT had sensitivities (97 vs. 58%; p < 0.001), specificities (77 vs. 95%, p = NS), positive predictive values (PPV) (88 vs. 96%; p = NS) and negative predictive values (NPV) (94% vs. 57%; p = NS), respectively. In predicting MI, the two tests had sensitivities (93 vs. 93%; p = NS), specificities (37 vs. 78%; p < 0.001), PPVs (31 vs. 57%; p = NS) and NPVs (94 vs. 97%; p = NS), respectively.
These results suggest that in patients with rest angina (1) TnT elevation is associated with the extent of myocardial perfusion defect; (2) both tests are valuable, while positive RPI is more sensitive in predicting all cardiac events irrespective of TnT; both positive TnT and positive RPI predict a high probability to have MI; (3) both negative test results predict a very low probability to have cardiac event, including MI.
肌钙蛋白T（TnT）和静息灌注成像（RPI）已被报道为胸痛患者危险分层的重要诊断工具。
我们调查了60例在入院前最后6小时内出现典型静息胸痛的患者中这两种方法之间的关联。所有患者均接受了Tc-99m门控单光子发射计算机断层扫描（SPECT）成像和TnT系列测量，并随访30天观察不良心脏事件的发生情况。
42例患者检测到灌注缺损，23例患者观察到TnT升高。所有TnT升高的患者在RPI中也有灌注缺损。TnT水平正常的患者中有一半（51%）在RPI中检测到灌注缺损（p = 无显著性差异）。TnT水平升高的患者比TnT水平正常的患者有更多的灌注缺损数量（8.2±2.9对5.3±2.2；p = 0.0007）。38例患者发生心脏事件（14例心肌梗死，24例血运重建）。在预测心脏事件方面，RPI和TnT的敏感性分别为（97%对58%；p < 0.001）、特异性（77%对95%，p = 无显著性差异）、阳性预测值（PPV）（88%对96%；p = 无显著性差异）和阴性预测值（NPV）（94%对57%；p = 无显著性差异）。在预测心肌梗死方面，这两种检测的敏感性分别为（93%对93%；p = 无显著性差异）、特异性（37%对78%；p < 0.001）、PPV（31%对57%；p = 无显著性差异）和NPV（94%对97%；p = 无显著性差异）。
这些结果表明，在静息性心绞痛患者中：（1）TnT升高与心肌灌注缺损的程度相关；（2）两种检测都有价值，而阳性RPI在预测所有心脏事件时更敏感，与TnT无关；TnT阳性和RPI阳性均预测发生心肌梗死的可能性很高；（3）两种检测结果均为阴性预测发生心脏事件（包括心肌梗死）的可能性非常低。
