Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Ann Nucl Med. 2009 Nov;23(9):793-8. doi: 10.1007/s12149-009-0307-8. Epub 2009 Sep 30.
A mismatch defect between (201)TL and (123)I-BMIPP dual isotope SPECT (d-SPECT) is useful to detect myocardial ischemia in patients with acute coronary syndrome. However, whether mismatched d-SPECT findings reflect actual myocardial ischemia in stable patients with suspected, but unknown ischemic heart disease is unclear. The present study assesses the significance of a d-SPECT mismatch among such patients.
Forty-nine patients with suspected stable coronary heart disease who had been referred for chest pain, ECG abnormalities or multiple risk factors (66 +/- 11 years old, 34 males) with a d-SPECT mismatch participated in this study. All of them underwent coronary angiography (CAG) to assess coronary artery disease. The entire myocardial area on d-SPECT images was divided into 17 segments, each of which was scored from 0 (normal) to 4 (defect). The d-SPECT mismatch score (MS) was defined as the summed BMIPP defect score (BM-TDS) minus the summed defect score (TL-TDS). The inclusion criterion was MS >or= 1, and the mismatch was defined as true positive if the mismatched area was concordant with the territories supplied by significant coronary stenotic arteries by CAG.
Ischemic heart disease was judged by coronary angiography in 31 (63%) patients (IHD group), of which 24 (49.0%) were true positives. Of the remaining 18 (37%) patients without no significant coronary stenosis (non-IHD group), 12 (24%) had some types of organic heart disease. If MS >or= 4 was defined as the threshold for an ischemic positive mismatch, then the sensitivity and specificity were 80% and 63%, respectively. However, mismatch scores did not significantly differ between the groups with true positive-IHD and organic heart disease in non-IHD group (6.6 +/- 4.4 vs. 6.4 +/- 3.7).
A d-SPECT mismatch score of >or=4 was an appropriate cutoff at which diagnosis of myocardial ischemia in patients who were screened for ischemic heart disease. However, since patients with non-ischemic but organic heart disease can also present with abnormal mismatch findings, coronary angiography or CT might be warranted to differentiate IHD from non-IHD.
（201）TL 和（123）I-BMIPP 双同位素单光子发射计算机断层扫描（d-SPECT）之间的不匹配缺陷可用于检测急性冠状动脉综合征患者的心肌缺血。然而，在患有可疑但未知缺血性心脏病的稳定患者中，不匹配的 d-SPECT 结果是否反映实际的心肌缺血尚不清楚。本研究评估了此类患者中 d-SPECT 不匹配的意义。
49 例因胸痛、心电图异常或多种危险因素而疑似稳定型冠心病（66 ± 11 岁，男性 34 例）的患者接受了 d-SPECT 检查，这些患者均进行了冠状动脉造影（CAG）以评估冠状动脉疾病。将 d-SPECT 图像上的整个心肌区域分为 17 个节段，每个节段的评分范围为 0（正常）至 4（缺损）。d-SPECT 不匹配评分（MS）定义为 BMIPP 缺陷评分总和（BM-TDS）减去 TL 缺陷评分总和（TL-TDS）。纳入标准为 MS≥1，并且如果不匹配区域与 CAG 显示的有意义的冠状动脉狭窄动脉供应的区域一致，则将不匹配定义为真阳性。
根据冠状动脉造影结果，31 例（63%）患者（IHD 组）被诊断为缺血性心脏病，其中 24 例（49.0%）为真阳性。在其余 18 例（37%）无明显冠状动脉狭窄的患者（非 IHD 组）中，有 12 例（24%）患有某种类型的器质性心脏病。如果将 MS≥4 定义为缺血性阳性不匹配的阈值，则敏感性和特异性分别为 80%和 63%。然而，在 IHD 组的真阳性与非 IHD 组的器质性心脏病患者之间，不匹配评分没有显著差异（6.6 ± 4.4 比 6.4 ± 3.7）。
在筛查缺血性心脏病的患者中，d-SPECT 不匹配评分≥4 是诊断心肌缺血的适当截断值。然而，由于患有非缺血性但器质性心脏病的患者也可能出现异常的不匹配发现，因此可能需要进行冠状动脉造影或 CT 以区分 IHD 与非 IHD。
Zotero 插件