Lette J, Lapointe J, Waters D, Cerino M, Picard M, Gagnon A
Maisonneuve Hospital, Montreal, Quebec, Canada.
Am J Cardiol. 1990 Nov 15;66(17):1163-70. doi: 10.1016/0002-9149(90)91092-k.
Transient left ventricular (LV) cavitary dilation during dipyridamole-thallium imaging was reported in 45 of 510 (9%) consecutive patients referred for dipyridamole-thallium imaging. Clinical and hemodynamic effects observed during dipyridamole infusion were not predictive of transient cavitary dilation on the thallium images. Coronary angiography was performed in 32 of the 45 patients: 75% had either left main, 3-vessel or "high-risk" 2-vessel coronary artery disease. Although 25 of 45 patients (56%) with transient cavitary dilation were either asymptomatic or had only grade 1/4 effort angina, 16 of 25 patients (64%) not referred for coronary revascularization sustained a cardiac event during a mean follow-up of 12 months. Most events were cardiac deaths (75%) and 87% of events occurred within 4 months of the test. Noncardiac surgery was performed in 187 of the 510 patients. The postoperative cardiac event rate was 2% in the 101 patients with normal scans or fixed defects, 19% in 75 patients with reversible perfusion defects and 58% in 12 patients with reversible cavitary dilation (p less than 0.0001). Thus, transient LV dilation during dipyridamole-thallium imaging is a marker of severe underlying coronary artery disease, denotes a poor prognosis and predicts a high risk of postoperative cardiac complications in patients who undergo noncardiac surgery.
在连续接受双嘧达莫 - 铊显像的510例患者中，有45例（9%）在双嘧达莫 - 铊显像期间出现短暂性左心室（LV）腔扩张。双嘧达莫输注期间观察到的临床和血流动力学效应并不能预测铊图像上的短暂性腔扩张。45例患者中有32例进行了冠状动脉造影：75%患有左主干、三支血管或“高危”双支冠状动脉疾病。虽然45例出现短暂性腔扩张的患者中有25例（56%）无症状或仅有1/4级劳力性心绞痛，但在平均12个月的随访中，25例未接受冠状动脉血运重建的患者中有16例（64%）发生了心脏事件。大多数事件为心源性死亡（75%），87%的事件发生在检查后4个月内。510例患者中有187例接受了非心脏手术。在扫描正常或有固定缺损的101例患者中，术后心脏事件发生率为2%；在有可逆性灌注缺损的75例患者中为19%；在有可逆性腔扩张的12例患者中为58%（p<0.0001）。因此，双嘧达莫 - 铊显像期间的短暂性左心室扩张是严重潜在冠状动脉疾病的一个标志，预示预后不良，并预测接受非心脏手术患者术后发生心脏并发症的高风险。
