Cardiovascular Medicine Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Arnaldo, 255, São Paulo, SP, 05430-000, Brazil.
Eur Heart J Cardiovasc Imaging. 2021 Oct 19;22(11):1341-1349. doi: 10.1093/ehjci/jeaa128.
We analysed whether incorporating electrocardiographic interlead T-wave heterogeneity (TWH) with myocardial perfusion imaging (MPI) during pharmacologic stress improves detection of flow-limiting lesions (FLL).
Medical records of all 103 patients at our institution who underwent stress testing with regadenoson (0.4 mg IV bolus) within 3 months of coronary angiography from September 2017 to March 2019 were studied. Cases (N = 59) had angiographically significant FLL (≥50% of left main or ≥70% of other epicardial coronary arteries ≥2 mm in diameter); controls (N = 44) were normal or had non-FLL. TWH, i.e., interlead splay of T waves, was assessed from precordial leads V4-6 by second central moment analysis. Maximum TWHV4-6 levels during regadenoson stress were 68% higher in cases than in controls (P < 0.0001). TWHV4-6 generated areas under the receiver-operating characteristic (ROC) curve of 0.79 in men (P < 0.0001) and 0.71 in women (P = 0.007). In men, the ROC-guided 54-µV TWHV4-6 cut-point for FLL produced adjusted odds of 7.3 [95% confidence interval (CI): 1.3-41.5, P = 0.03], 79% sensitivity, and 78% specificity. In women, the ROC-guided 35-µV TWHV4-6 cut-point produced adjusted odds of 4.5 (95% CI: 1.1-18.9, P = 0.04), 84% sensitivity, and 52% specificity. Adding TWHV4-6 to MPI determinations reduced false-positive results by 70%, more than doubled true-negative results, and improved adjusted odds ratio to 6.8 (95% CI: 2.2-21.4, P = 0.001) with specificity of 78% in men and 86% in women.
This observational study is the first to demonstrate the benefit of combining TWHV4-6 with MPI to enhance FLL detection during MPI with regadenoson in both men and women.
我们分析了在药物负荷状态下结合心电图导联间 T 波异质性（TWH）与心肌灌注成像（MPI）是否能提高对血流限制病变（FLL）的检出率。
研究纳入了 2017 年 9 月至 2019 年 3 月我院 103 例在冠状动脉造影后 3 个月内接受雷加腺苷（0.4mg 静脉推注）负荷试验的患者的病历资料。病例组（N=59）有血管造影显著的 FLL（≥50%的左主干或≥70%的其他心外膜冠状动脉≥2mm 直径）；对照组（N=44）为正常或非 FLL。TWH 即 T 波的导联间离散，通过第二中心矩分析从胸前导联 V4-6 进行评估。病例组在雷加腺苷负荷时的最大 TWHV4-6 水平比对照组高 68%（P<0.0001）。TWHV4-6 在男性中的受试者工作特征（ROC）曲线下面积为 0.79（P<0.0001），在女性中为 0.71（P=0.007）。在男性中，ROC 指导的 FLL 54µVTWHV4-6 截断值产生的校正比值比为 7.3（95%可信区间：1.3-41.5，P=0.03），敏感性为 79%，特异性为 78%。在女性中，ROC 指导的 35µVTWHV4-6 截断值产生的校正比值比为 4.5（95%可信区间：1.1-18.9，P=0.04），敏感性为 84%，特异性为 52%。在 MPI 检测中加入 TWHV4-6 可使假阳性结果减少 70%，真阴性结果增加一倍以上，调整后的优势比为 6.8（95%可信区间：2.2-21.4，P=0.001），男性特异性为 78%，女性特异性为 86%。
本观察性研究首次证明，在男女患者中，结合 TWHV4-6 与 MPI 可提高雷加腺苷 MPI 检查中 FLL 的检出率。
