Department of Nuclear Medicine, University of Patras Medical School, University Hospital of Patras, Rion, Patras, Greece.
Eur J Nucl Med Mol Imaging. 2012 Mar;39(3):437-45. doi: 10.1007/s00259-011-2007-6. Epub 2011 Dec 8.
The prognostic value of electrocardiographic (ECG) ST-segment depression during vasodilator stress testing in patients with normal myocardial perfusion scintigraphy (MPS) is based on retrospective studies with controversial results. Moreover, the true incidence of obstructive coronary artery disease (CAD) in these patients is unknown.
During a 33-month period, all consecutive patients referred for MPS were prospectively evaluated for interpretable ST-segment depression ≥ 1 mm during vasodilator stress testing. Of 1,687 patients with normal MPS and without known CAD, 109 (100 women) aged 65.2 ± 9.2 years demonstrated ST-segment shifts and formed the ECG-positive group. The pretest probability of CAD was low in 56%, intermediate in 39% and high in 5%. They were advised to proceed to coronary angiography. An equal number of patients with normal MPS and no ECG abnormalities matched for CAD predisposing factors comprised the control group. Follow-up of both groups was accomplished through a telephone interview.
Fifty-two patients from the ECG-positive group (48%) consented to coronary angiography. Six (11.5%) had obstructive CAD (≥50% lumen stenosis), one with left main artery disease, while three required revascularization. Follow-up was complete in 99 ECG-positive patients for a period of 20.6 ± 8.9 months. One hard event (non-fatal myocardial infarction) and one soft event (revascularization) were observed. No event was recorded in the control group.
In patients with low-intermediate risk of CAD, "ischaemic" ECG changes during vasodilator stress combined with normal MPS are encountered mostly in women and are associated with a low prevalence of significant CAD and a low cardiac event rate.
在心肌灌注闪烁显像（MPS）正常的患者中，血管扩张剂负荷试验时心电图（ECG）ST 段压低的预后价值基于回顾性研究，结果存在争议。此外，这些患者中真正的阻塞性冠状动脉疾病（CAD）的发生率尚不清楚。
在 33 个月期间，所有连续因 MPS 就诊的患者均前瞻性评估血管扩张剂负荷试验时是否存在可解释的≥1mm 的 ST 段压低。在 1687 例 MPS 正常且无已知 CAD 的患者中，有 109 例（100 例为女性）年龄为 65.2±9.2 岁，ST 段移位并形成心电图阳性组。CAD 的术前概率在 56%为低危，39%为中危，5%为高危。他们被建议进行冠状动脉造影。与心电图正常且无心电图异常的患者相匹配，按照 CAD 易患因素进行了匹配，对照组包括 109 例患者。两组的随访均通过电话访谈进行。
心电图阳性组中有 52 例（48%）患者同意进行冠状动脉造影。6 例（11.5%）有阻塞性 CAD（≥50%管腔狭窄），1 例合并左主干病变，3 例需要血运重建。99 例心电图阳性患者的随访时间为 20.6±8.9 个月。1 例发生硬终点（非致死性心肌梗死）和 1 例发生软终点（血运重建）。对照组未记录到任何事件。
在 CAD 低危-中危患者中，血管扩张剂负荷试验时出现“缺血性”心电图改变且 MPS 正常的情况主要发生在女性中，与 CAD 发生率低和心脏不良事件发生率低相关。
