Kaul Sanjiv, Senior Roxy, Firschke Christian, Wang Xin-Qun, Lindner Jonathan, Villanueva Flordeliza S, Firozan Soroosh, Kontos Michael C, Taylor Allen, Nixon Ian J, Watson Denny D, Harrell Frank E
Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia, Charlottesville, Va 22908-0158, USA.
Am Heart J. 2004 Jul;148(1):129-36. doi: 10.1016/j.ahj.2003.12.041.
We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram.
We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death.
Concordance between CE and SPECT was 77% (73% to 82%) for all territories, with a higher concordance for the anterior wall of 84% (78% to 89%). Of the 203 patients recruited for the study, 38 (19%) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors (P <.05) of cardiac events. The composite scores on CE provided 17% incremental information (P =.009, n = 203) and gated SPECT provided 23.5% additional information (P =.020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not.
Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.
我们假设，对于因胸痛就诊于急诊科（ED）且心电图无ST段抬高的患者，区域心肌功能（RF）和灌注（PER）成像将为诊断和短期预后提供比常规人口统计学、临床和心电图检查结果更多的价值。
为此，我们将对比超声心动图（CE）与门控单光子发射计算机断层扫描（SPECT）进行了比较。CE和SPECT读数均包括对RF和PER的单独及综合评估。ED就诊后48小时内的不良事件包括急性心肌梗死、紧急血运重建和心脏相关死亡。
所有区域CE和SPECT之间的一致性为77%（73%至82%），前壁的一致性更高，为84%（78%至89%）。在纳入该研究的203例患者中，38例（19%）在ED就诊后48小时内发生了心脏事件：21例发生急性心肌梗死，16例接受了紧急血运重建手术，1例死亡。在多变量逻辑回归模型中，CE和SPECT上异常节段的数量是心脏事件的显著预测因素（P<.05）。与常规人口统计学、临床和心电图变量相比，CE的综合评分在预测心脏事件方面提供了17%的增量信息（P=.009，n = 203），门控SPECT提供了23.5%的额外信息（P =.020，n = 163）。与CE相比，SPECT上的RF和综合评估更优，而单独的PER则不然。
对于因胸痛且无ST段抬高就诊于ED的患者，在ED就诊时进行RF和PER的心脏成像比常规人口统计学、临床和心电图评估能为早期心脏事件提供更多的诊断和预后信息。
