心肌灌注成像中缺血严重程度对疑似冠心病老年人的诊断价值。

Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease.

作者信息

Canepa Marco, Bezante Gianpaolo, Vianello Pierfilippo, Ameri Pietro, Milaneschi Yuri, Aste Milena, Cavalla Francesca, Bauckneht Matteo, Marini Cecilia, Balbi Manrico, Brunelli Claudio, Sambuceti Gianmario

机构信息

aCardiovascular Unit, Department of Internal Medicine, University of Genova, Genova, Italy bLongitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, Maryland, USA cDepartment of Psychiatry, VU University Medical Center/GGZ in Geest, Amsterdam, The Netherlands dNuclear Medicine, Department of Health Science, University of Genova, Genova, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2016 Oct;17(10):719-28. doi: 10.2459/JCM.0000000000000339.

DOI:10.2459/JCM.0000000000000339

PMID:26599683

Abstract

AIMS

Myocardial perfusion and ischemia scores obtained from myocardial perfusion scintigraphy (MPS) have strong independent prognostic value in elderly individuals without known coronary artery disease (CAD). Herein we aimed to assess their independent diagnostic value and accuracy for CAD while considering different thresholds of myocardial ischemia.

METHODS

We estimated the summed rest score (SRS), summed stress score (SSS) and summed difference score (SDS) in 322 elderly individuals (mean age 72 ± 7 years, 68% men) who underwent coronary angiography following an MPS. Abnormal perfusion at stress was defined as an SSS greater than 3, and ischemia as an SDS of at least 2, and further categorized as mild (2-4), moderate (5-7) or severe (>7). Multivariate logistic regressions were used to establish the independent diagnostic value and accuracy of MPS parameters.

RESULTS

CAD was diagnosed in 182 individuals (56%). In multivariate analysis accounting for clinical variables associated with CAD including the Framingham risk score, both SRS [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01-1.18, P = 0.03] and SSS (OR 1.10, 95% CI 1.04-1.16, P = 0.0006) and SDS (OR 1.12, 95% CI 1.04-1.21, P = 0.003) were independently associated with CAD. An SSS greater than 3 was also independently associated with CAD (OR 2.51, 95% CI 1.43-4.39, P = 0.0013), whereas an SDS of 2 or greater was not (OR 1.62, 95% CI 0.89-2.93, P = 0.12), but only when at least 5 (OR 2.31, 95% CI 1.32-4.03, P = 0.003). The probability of CAD was proportional to the amount of myocardial ischemia in those with an SSS greater than 3, and lower and comparable in those with an SSS of at least 3 or an SSS greater than 3 with SDS of 1 or less (P = 0.19). Increasing the threshold of myocardial ischemia determined a decrease in sensitivity and increase in specificity of MPS for both diagnosis and severity of CAD.

CONCLUSION

We established the diagnostic value and accuracy of continuous scores and thresholds of abnormal myocardial perfusion and ischemia previously validated in prognostic studies. Their more widespread use could potentially improve the diagnostic yield of coronary angiography in elderly individuals with suspected CAD.

摘要

目的

从心肌灌注闪烁显像（MPS）获得的心肌灌注和缺血评分在无已知冠状动脉疾病（CAD）的老年人中具有很强的独立预后价值。在此，我们旨在评估其在考虑不同心肌缺血阈值时对CAD的独立诊断价值和准确性。

方法

我们对322名老年人（平均年龄72±7岁，68%为男性）进行了评估，这些老年人在MPS检查后接受了冠状动脉造影，计算其静息总评分（SRS）、负荷总评分（SSS）和差值总评分（SDS）。负荷时的异常灌注定义为SSS大于3，缺血定义为SDS至少为2，并进一步分为轻度（2 - 4）、中度（5 - 7）或重度（>7）。采用多因素逻辑回归来确定MPS参数的独立诊断价值和准确性。

结果

182名个体（56%）被诊断为CAD。在考虑与CAD相关的临床变量（包括弗雷明汉风险评分）的多因素分析中，SRS[比值比（OR）1.09，95%置信区间（CI）1.01 - 1.18，P = 0.03]、SSS（OR 1.10，95% CI 1.04 - 1.16，P = 0.0006）和SDS（OR 1.12，95% CI 1.04 - 1.21，P = 0.003）均与CAD独立相关。SSS大于3也与CAD独立相关（OR 2.51，95% CI 1.43 - 4.39，P = 0.0013），而SDS为2或更高则不然（OR 1.62，95% CI 0.89 - 2.93，P = 0.12），但仅当至少为5时（OR 2.31，95% CI 1.32 - 4.03，P = 0.003）。在SSS大于3的人群中，CAD的概率与心肌缺血量成正比，而在SSS至少为3或SSS大于3且SDS为1或更低的人群中，概率较低且相当（P = 0.19）。提高心肌缺血阈值会导致MPS对CAD诊断和严重程度的敏感性降低而特异性增加。