Zaman M M, Haque S S, Siddique M A, Banerjee S, Ahmed C M, Sharma A K, Rahman M F, Haque M H, Joarder A I, Sultan A U, Fatema K
Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka, Bangladesh.
Mymensingh Med J. 2010 Oct;19(4):608-13.
Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.
人们开发了许多非侵入性技术来评估冠状动脉疾病（CAD）的严重程度。冠状动脉造影（CAG）是诊断和量化冠状动脉狭窄严重程度的既定方法。使用锝-99m（Tc-99m）替曲膦的单光子发射计算机断层扫描-心肌灌注成像（SPECT-MPI）也是评估CAD严重程度的一种有用的既定技术。本前瞻性观察性研究在孟加拉国谢赫穆吉布医科大学（BSMMU）开展，旨在使用Tc-99m单光子发射计算机断层扫描心肌灌注成像（SPECT-MPI）与CAG对比，评估冠状动脉狭窄的严重程度。研究了82例连续患者，平均年龄53.51（标准差±7.08）岁，胸痛严重程度为加拿大心血管学会（CCS）I级和II级，男女比例为4.8:1。Tc-99m SPECT-MPI通过一日运动负荷和静息方案进行。本研究共检查了246个冠状动脉节段。通过CAG发现76个冠状动脉节段冠状动脉正常，24个节段有中度狭窄，146个节段有重度狭窄；而SPECT-MPI发现27个冠状动脉节段灌注正常，17个节段有轻度灌注异常，32个节段有中度灌注异常，165个节段有重度灌注异常。使用Tc-99m替曲膦的SPECT-MPI检测冠状动脉狭窄的敏感性和特异性分别为87.09%和80.95%。该检测的阳性预测值、阴性预测值和准确性分别为91.01%、73.91%和85.18%。从本研究可以得出结论，Tc-99m SPECT-MPI是检测冠状动脉病变严重程度的一种安全、有效且出色的非侵入性工具，可用于预测CAD的严重程度。
