Iskandrian A S, Heo J, Kong B, Lyons E
Philadelphia Heart Institute, Presbyterian Medical Center, Pennsylvania 19104.
J Am Coll Cardiol. 1989 Nov 15;14(6):1477-86. doi: 10.1016/0735-1097(89)90385-9.
This study examined the effect of the level of exercise on the ability of thallium-201 imaging with single photon emission computed tomography (SPECT) to detect coronary artery disease. Patients in group 1 (n = 164) achieved adequate exercise end points, defined as positive exercise electrocardiograms or greater than or equal to 85% of maximal predicted heart rate. Patients in group 2 (n = 108) had submaximal exercise. The SPECT thallium-201 images showed perfusion defects in 74%, 88%, and 98%, respectively, of patients with one, two and three vessel coronary artery disease in group 1, compared with 52%, 84% and 79%, respectively, of such patients in group 2 (p less than 0.05). Perfusion defects showed partial or complete redistribution consistent with ischemia in 56%, 80% and 88%, respectively, of patients with one, two and three vessel coronary artery disease in group 1 compared with 35%, 58% and 56%, respectively, of such patients in group 2 (p = 0.08, less than 0.03 and less than 0.001, respectively). Of 58 patients with normal coronary angiograms or less than 50% diameter stenosis, 36 (62%) had normal SPECT images. In a separate group of 131 patients with less than 5% pretest probability of coronary artery disease, the specificity was 93%. The sensitivity of exercise SPECT imaging in group 1 was higher than that of ST segment depression (p less than 0.001). Thus, the level of exercise affects the results of SPECT thallium imaging in the localization and evaluation of the extent of coronary artery disease and the detection of ischemia.
本研究探讨了运动水平对利用单光子发射计算机断层扫描（SPECT）进行铊-201心肌灌注显像检测冠状动脉疾病能力的影响。第1组患者（n = 164）达到了足够的运动终点，定义为运动心电图阳性或心率达到最大预测心率的85%及以上。第2组患者（n = 108）进行的是次极量运动。SPECT铊-201心肌灌注显像显示，第1组中，单支、双支和三支冠状动脉疾病患者出现灌注缺损的比例分别为74%、88%和98%，而第2组中此类患者的相应比例分别为52%、84%和79%（p<0.05）。第1组中，单支、双支和三支冠状动脉疾病患者出现与心肌缺血一致的部分或完全再分布的灌注缺损比例分别为56%、80%和88%，而第2组中此类患者的相应比例分别为35%、58%和56%（p分别为0.08、<0.03和<0.001）。在58例冠状动脉造影正常或直径狭窄小于50%的患者中，36例（62%）的SPECT显像正常。在另一组131例冠心病预测试验概率小于5%的患者中，特异性为93%。第1组中运动SPECT显像的敏感性高于ST段压低（p<0.001）。因此，运动水平会影响SPECT铊心肌灌注显像在冠状动脉疾病定位、范围评估及心肌缺血检测方面的结果。
