Metz Louise D, Beattie Mary, Hom Robert, Redberg Rita F, Grady Deborah, Fleischmann Kirsten E
Department of Medicine, New York University School of Medicine, New York, New York, USA.
J Am Coll Cardiol. 2007 Jan 16;49(2):227-37. doi: 10.1016/j.jacc.2006.08.048. Epub 2006 Dec 29.
The purpose of this work was to determine the prognostic value of normal exercise myocardial perfusion imaging (MPI) tests and exercise echocardiography tests, and to determine the prognostic value of these imaging modalities in women and men.
Exercise MPI and exercise echocardiography provide prognostic information that is useful in the risk stratification of patients with suspected coronary artery disease (CAD).
We searched the PubMed, Cochrane, and DARE databases between January 1990 and May 2005, and reviewed bibliographies of articles obtained. We included prospective cohort studies of subjects who underwent exercise MPI or exercise echocardiography for known or suspected CAD, and provided data on primary outcomes of myocardial infarction (MI) and cardiac death with at least 3 months of follow-up. Secondary outcomes (unstable angina, revascularization procedures) were abstracted if provided. Studies performed exclusively in patients with CAD were excluded.
The negative predictive value (NPV) for MI and cardiac death was 98.8% (95% confidence interval [CI] 98.5 to 99.0) over 36 months of follow-up for MPI, and 98.4% (95% CI 97.9 to 98.9) over 33 months for echocardiography. The corresponding annualized event rates were 0.45% per year for MPI and 0.54% per year for echocardiography. In subgroup analyses, annualized event rates were <1% for each MPI isotope, and were similar for women and men. For secondary events, MPI and echocardiography had annualized event rates of 1.25% and 0.95%, respectively.
Both exercise MPI and exercise echocardiography have high NPVs for primary and secondary cardiac events. The prognostic utility of both modalities is similar for both men and women.
本研究旨在确定正常运动心肌灌注成像（MPI）检查和运动超声心动图检查的预后价值，并确定这些成像方式在男性和女性中的预后价值。
运动MPI和运动超声心动图可提供预后信息，有助于对疑似冠心病（CAD）患者进行危险分层。
我们检索了1990年1月至2005年5月期间的PubMed、Cochrane和DARE数据库，并查阅了所获文章的参考文献。我们纳入了对已知或疑似CAD患者进行运动MPI或运动超声心动图检查的前瞻性队列研究，并提供了至少3个月随访期内心肌梗死（MI）和心源性死亡的主要结局数据。如有提供，还提取了次要结局（不稳定型心绞痛、血运重建术）。排除仅在CAD患者中进行的研究。
在36个月的随访期内，MPI对MI和心源性死亡的阴性预测值（NPV）为98.8%（95%置信区间[CI]98.5至99.0），在33个月的随访期内，超声心动图的NPV为98.4%（95%CI 97.9至98.9）。MPI的相应年化事件发生率为每年0.45%，超声心动图为每年0.54%。在亚组分析中，每种MPI同位素的年化事件发生率均<1%，且男女相似。对于次要事件，MPI和超声心动图的年化事件发生率分别为1.25%和0.95%。
运动MPI和运动超声心动图对心脏主要和次要事件均具有较高的NPV。这两种检查方式对男性和女性的预后效用相似。
