Stewart R E, Kander N, Juni J E, Ellis S G, O'Neill W W, Schork M A, Topol E J, Schwaiger M
Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028.
Am Heart J. 1991 Apr;121(4 Pt 1):1033-41. doi: 10.1016/0002-8703(91)90660-a.
Submaximal thallium-201 stress testing has been shown to provide important diagnostic and prognostic information in patients with acute myocardial infarction. The purpose of this investigation was to evaluate the diagnostic value of early submaximal stress testing and thallium-201 single photon emission computed tomography (SPECT) after interventional therapy. Scintigraphic results from 56 patients with infarctions, who underwent acute thrombolytic therapy, angioplasty, or both, were compared with late (6 weeks) functional outcome as assessed by radionuclide ventriculography and with results of discharge coronary angiography. A linear correlation was found between the extent of thallium-201 SPECT perfusion defect and late ventricular function (r = 0.74, p less than 0.01). Forty-two percent of patients with large SPECT perfusion defects had normal left ventricular ejection fractions, suggesting an overestimation of infarct size by early imaging. Sensitivity and specificity of thallium-201 SPECT for detection of coronary artery stenosis in noninfarct territories was 57% and 46%, respectively, indicating limited diagnostic definition of extent of underlying coronary artery disease. Results of follow-up coronary angiography showed a significant relationship between the size of the initial perfusion defect and early restenosis or reocclusion of the infarct artery. Thus the extent of early thallium-201 perfusion defects correlates with late functional outcome but appears to overestimate the degree of injury. Submaximal thallium-201 stress testing allows only limited characterization of underlying coronary artery disease. Early assessment of infarct size may identify a patient population at high risk for reocclusion of the infarct artery.
次极量铊-201负荷试验已被证明能为急性心肌梗死患者提供重要的诊断和预后信息。本研究的目的是评估介入治疗后早期次极量负荷试验及铊-201单光子发射计算机断层扫描（SPECT）的诊断价值。将56例接受急性溶栓治疗、血管成形术或两者皆有的梗死患者的闪烁扫描结果，与通过放射性核素心室造影评估的晚期（6周）功能结局以及出院时冠状动脉造影结果进行比较。发现铊-201 SPECT灌注缺损范围与晚期心室功能之间存在线性相关性（r = 0.74，p < 0.01）。42%的SPECT灌注缺损较大的患者左心室射血分数正常，提示早期成像高估了梗死面积。铊-201 SPECT检测非梗死区域冠状动脉狭窄的敏感性和特异性分别为57%和46%，表明对潜在冠状动脉疾病范围的诊断界定有限。随访冠状动脉造影结果显示，初始灌注缺损大小与梗死动脉早期再狭窄或再闭塞之间存在显著关系。因此，早期铊-201灌注缺损范围与晚期功能结局相关，但似乎高估了损伤程度。次极量铊-201负荷试验对潜在冠状动脉疾病的特征描述有限。早期评估梗死面积可能有助于识别梗死动脉再闭塞高危患者群体。
