Esteves Fabio P, Sanyal Rupan, Santana Cesar A, Shaw Leslee, Raggi Paolo
Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Cardiol. 2008 Jan 15;101(2):149-52. doi: 10.1016/j.amjcard.2007.08.055.
We investigated the ability of coronary artery calcium (CAC) to predict a normal adenosine stress rubidium-82 (Rb-82) myocardial perfusion positron emission tomography (PET) in patients admitted to the chest pain unit. Eighty-four consecutive patients (33 men; mean age 62 +/- 14.8 years) with low to intermediate likelihood of coronary artery disease were included. A single noncontrast computed tomogram under shallow breathing was obtained for attenuation correction and to assess the presence of CAC. This was followed by a rest and adenosine stress dynamic Rb-82 emission PET. Computed tomography and PET images were interpreted independently. There was a high prevalence of risk factors (80% hypertension, 30% diabetes, 38% hypercholesterolemia, 13% smoking); prior coronary revascularization and myocardial infarction were present in 21% and 15% of the patients, respectively. The absence of CAC was associated with a normal adenosine stress Rb-82 myocardial perfusion PET in 34 of 34 patients, yielding a negative predictive value of 100%. The presence of CAC (50 of 84) was associated with a higher incidence of myocardial perfusion defects (13 of 50), yielding a positive predictive value of 26%. Sensitivity was 100% (13 of 13) and specificity was 48% (34 of 71). In conclusion, the absence of CAC is predictive of a normal adenosine stress Rb-82 myocardial perfusion PET in patients admitted to the chest pain unit. If these results are confirmed, myocardial perfusion imaging probably can be safely avoided in chest pain patients with negative CAC with low to intermediate pretest likelihood of disease. This approach may decrease overall radiation exposure and hospital time and prove to be cost effective.
我们研究了冠状动脉钙化（CAC）对胸痛单元收治患者腺苷负荷铷-82（Rb-82）心肌灌注正电子发射断层扫描（PET）结果正常的预测能力。纳入了84例连续的冠状动脉疾病可能性为低到中度的患者（33例男性；平均年龄62±14.8岁）。在浅呼吸状态下进行一次非增强计算机断层扫描以进行衰减校正并评估CAC的存在情况。随后进行静息和腺苷负荷动态Rb-82发射PET检查。计算机断层扫描和PET图像由不同人员独立解读。危险因素的患病率很高（80%高血压、30%糖尿病、38%高胆固醇血症、13%吸烟）；分别有21%和15%的患者曾接受过冠状动脉血运重建和心肌梗死。34例患者中，无CAC与腺苷负荷Rb-82心肌灌注PET结果正常相关，阴性预测值为100%。存在CAC（84例中的50例）与心肌灌注缺损发生率较高相关（50例中的13例），阳性预测值为26%。敏感性为100%（13例中的13例），特异性为48%（71例中的34例）。总之，无CAC可预测胸痛单元收治患者的腺苷负荷Rb-82心肌灌注PET结果正常。如果这些结果得到证实，对于疾病预测前可能性为低到中度且CAC为阴性的胸痛患者，可能可以安全地避免进行心肌灌注成像检查。这种方法可能会降低总体辐射暴露和住院时间，并证明具有成本效益。
