双嘧达莫超声心动图或闪烁扫描术在诊断合并左束支传导阻滞及左心室功能不全患者冠状动脉疾病中的准确性

Inaccuracy of dipyridamole echocardiography or scintigraphy for the diagnosis of coronary artery disease in patients with both left bundle branch block and left ventricular dysfunction.

作者信息

Vigna Carlo, Stanislao Mario, De Rito Vincenzo, Russo Aldo, Santoro Tiberio, Fusilli Saverio, Valle Guido, Natali Rosaria, Fanelli Raffaele, Lotrionte Marzia, Biondi-Zoccai Giuseppe, Loperfido Francesco

出版信息

Int J Cardiol. 2006 Jun 7;110(1):116-8. doi: 10.1016/j.ijcard.2005.05.068. Epub 2005 Jul 5.

DOI:10.1016/j.ijcard.2005.05.068

PMID:16002158

Abstract

Non-invasive diagnosis of coronary artery disease (CAD) in patients with left ventricular (LV) dysfunction and left bundle branch block (LBBB) remains challenging, and there is no consensus on the role of myocardial sesta-MIBI perfusion scintigraphy with pharmacological stress (dip-MIBI) or dipiridamole echocardiography (dip-ECHO). We thus performed a prospective study to test the diagnostic accuracy of such non-invasive tests. 27 consecutive patients with both LV dysfunction and LBBB undergoing diagnostic work-up for CAD were studied simultaneously with dip-ECHO and dip-MIBI. The sensitivity for CAD for dip-ECHO and dip-MIBI was respectively 42% and 67%, with specificity 93% and 53%, and likelihood ratio (LR)-positive 6.3 and LR-negative 0.6 for both. Given the low accuracy of both dip-ECHO and dip-MIBI in detecting CAD in patients with concomitant LV dysfunction and LBBB, coronary angiography should be performed as the default diagnostic strategy in such patients.

摘要

对左心室（LV）功能不全和左束支传导阻滞（LBBB）患者进行冠状动脉疾病（CAD）的无创诊断仍然具有挑战性，对于心肌 sestamibi 灌注闪烁扫描联合药物负荷试验（双嘧达莫 - MIBI，dip - MIBI）或双嘧达莫超声心动图（dip - ECHO）的作用尚无共识。因此，我们进行了一项前瞻性研究，以测试此类无创检查的诊断准确性。对 27 例同时患有 LV 功能不全和 LBBB 且正在接受 CAD 诊断检查的患者，同时进行 dip - ECHO 和 dip - MIBI 检查。dip - ECHO 和 dip - MIBI 对 CAD 的敏感性分别为 42%和 67%，特异性分别为 93%和 53%，两者的阳性似然比（LR）均为 6.3，阴性似然比（LR）均为 0.6。鉴于 dip - ECHO 和 dip - MIBI 在检测合并 LV 功能不全和 LBBB 的患者 CAD 方面准确性较低，冠状动脉造影应作为此类患者的默认诊断策略。