在无法进行运动试验的患者中，多巴酚丁胺负荷超声心动图与心肌灌注扫描的长期预后价值比较

Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests.

作者信息

Schinkel Arend F L, Bax Jeroen J, Elhendy Abdou, van Domburg Ron T, Valkema Roelf, Vourvouri Eleni, Bountioukos Manolis, Rizzello Vittoria, Biagini Elena, Agricola Eustachio, Krenning Eric P, Simoons Maarten L, Poldermans Don

机构信息

Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Am J Med. 2004 Jul 1;117(1):1-9. doi: 10.1016/j.amjmed.2004.01.021.

DOI:10.1016/j.amjmed.2004.01.021

PMID:15210381

Abstract

PURPOSE

To compare the long-term prognostic value of dobutamine stress echocardiography and dobutamine stress single photon emission computed tomography (SPECT) in patients unable to perform an exercise test.

METHODS

We assessed the prognostic value of dobutamine stress technetium 99m ((99m)Tc)-sestamibi SPECT and dobutamine stress echocardiography in 301 patients who were unable to perform exercise tests. Outcomes during a mean (+/- SD) follow-up of 7.3 +/- 2.8 years were overall death, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization.

RESULTS

Abnormal myocardial perfusion was detected in 66% of patients (n = 198), while 60% (n = 182) had an abnormal stress echocardiogram; agreement was 82% (kappa = 0.62). During the follow-up period, 100 deaths (33%) occurred, of which 43% were due to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularization. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after a normal scan, and 2.6% for cardiac death and 6.5% for all cardiac events after an abnormal scan (P <0.0001). For stress echocardiography, annual event rates were 0.6% for cardiac death and 3.3% for all cardiac events after a normal test, and 2.8% for cardiac death and 6.9% for all cardiac events after an abnormal test (P <0.0001).

CONCLUSION

Dobutamine stress (99m)Tc-sestamibi SPECT and dobutamine stress echocardiography provide comparable long-term prognostic information in addition to that afforded by clinical data.

摘要

目的

比较多巴酚丁胺负荷超声心动图和多巴酚丁胺负荷单光子发射计算机断层扫描（SPECT）对无法进行运动试验的患者的长期预后价值。

方法

我们评估了多巴酚丁胺负荷锝99m（99mTc）-甲氧基异丁基异腈SPECT和多巴酚丁胺负荷超声心动图对301例无法进行运动试验的患者的预后价值。在平均（±标准差）7.3±2.8年的随访期间，结局指标包括全因死亡、心源性死亡、非致死性心肌梗死和晚期（>60天）冠状动脉血运重建。

结果

66%（n = 198）的患者检测到心肌灌注异常，而60%（n = 182）的患者负荷超声心动图异常；一致性为82%（kappa = 0.62）。在随访期间，发生了100例死亡（33%），其中43%是心源性原因。23例患者（8%）发生非致死性心肌梗死，29例（10%）接受了晚期血运重建。对于负荷SPECT，正常扫描后心源性死亡的年发生率为0.7%，所有心脏事件的年发生率为3.6%，异常扫描后心源性死亡的年发生率为2.6%，所有心脏事件的年发生率为6.5%（P<0.0001）。对于负荷超声心动图，正常检查后心源性死亡的年发生率为0.6%，所有心脏事件的年发生率为3.3%，异常检查后心源性死亡的年发生率为2.8%，所有心脏事件的年发生率为6.9%（P<0.0001）。