Prisant L M, von Dohlen T W, Houghton J L, Carr A A, Frank M J
Department of Medicine, School of Medicine, Medical College of Georgia, Augusta 30912-3150.
Am J Hypertens. 1992 Feb;5(2):71-5. doi: 10.1093/ajh/5.2.71.
The operating characteristics of thallium stress testing for detection of significant epicardial coronary artery disease (CAD) in hypertensive subjects with chest pain or electrocardiographic (ECG) ischemia have not been previously defined. This becomes important because of the high prevalence of both hypertensive heart disease and CAD. Ninety-two hypertensives with a history of typical or atypical chest pain or ECG myocardial ischemia underwent coronary arteriography, 2D-guided echocardiography, and thallium-201 stress testing, combined with intravenous dipyridamole if the rate-pressure product was less than 20,000. Patients with myocardial infarction, prior revascularization procedure, valvular heart disease, and chronic ethanol abuse were excluded. The mean age was 54.8 +/- 9.9 years with 55% blacks and 46% women. Eighteen patients (19.6%) had significant (greater than or equal to 50% luminal diameter narrowing) epicardial CAD at catheterization, of whom 17 had positive thallium scans. Overall, there were 17 true positives, 47 true negatives, 27 false positives, and one false negative resulting in 94.4 +/- 5.4% sensitivity (95% confidence limits [95% CL] 71 to 100%), 63.5 +/- 5.6% specificity (95% CL 51 to 74%), 38.6 +/- 7.3% positive predictive value (95% CL 25 to 54%), 97.9 +/- 2.1% negative predictive value (95% CL 88 to 100%), and 69.6 +/- 4.8% overall accuracy (95% CL 59 to 79%). For hypertensive patients with chest pain or ECG myocardial ischemia, the high sensitivity and negative predictive value and low false negative rate support the role of thallium stress testing +/- dipyridamole as an exclusion test for significant CAD.
对于伴有胸痛或心电图（ECG）缺血的高血压患者，铊负荷试验用于检测显著的心外膜冠状动脉疾病（CAD）的操作特征此前尚未明确。鉴于高血压性心脏病和CAD的高患病率，这一点变得很重要。92例有典型或非典型胸痛病史或ECG心肌缺血的高血压患者接受了冠状动脉造影、二维超声心动图检查以及铊-201负荷试验，若心率-血压乘积小于20,000，则联合静脉注射双嘧达莫。排除有心肌梗死、既往血运重建手术史、心脏瓣膜病和慢性乙醇滥用的患者。平均年龄为54.8±9.9岁，其中55%为黑人，46%为女性。18例患者（19.6%）在导管插入术时存在显著（管腔直径狭窄大于或等于50%）的心外膜CAD，其中17例铊扫描阳性。总体而言，有17例假阳性，47例假阴性，27例假阳性和1例假阴性，敏感性为94.4±5.4%（95%置信区间[95%CL]71%至100%），特异性为63.5±5.6%（95%CL51%至74%），阳性预测值为38.6±7.3%（95%CL25%至54%），阴性预测值为97.9±2.1%（95%CL88%至100%），总体准确率为69.6±4.8%（95%CL59%至79%）。对于有胸痛或ECG心肌缺血的高血压患者，高敏感性、阴性预测值以及低假阴性率支持铊负荷试验±双嘧达莫作为显著CAD的排除试验。
