Pearlman J D, Boucher C A
Cardiac Unit, Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts 02114.
Am J Cardiol. 1988 Jan 1;61(1):43-5. doi: 10.1016/0002-9149(88)91301-x.
Intravenous dipyridamole with thallium imaging permits stress testing for coronary artery disease (CAD) without exercise. Chest pain may occur with dipyridamole-thallium testing, but its diagnostic significance is uncertain. Forty-five patients who had coronary angiography, no revascularization and chest pain during dipyridamole-thallium testing were identified. These patients were matched blindly by sex and age to 45 patients who had coronary angiography, no revascularization and no chest pain reported during the dipyridamole-thallium test. In the groups with versus without chest pain, 9 versus 24% had no CAD, 16 versus 16% had 1-vessel disease, 38 versus 29% had 2-vessel CAD and 38 versus 29% had 3-vessel CAD. These differences did not achieve statistical significance. Also, there were no evident differences in the severity of angiographic CAD by vessel or by percent of stenosis (p greater than 0.50). There was only a moderate association with ischemic ST changes (40 versus 16%, p less than 0.02). Chest pain with concurrent ischemic ST changes also failed to predict any difference in distribution or severity of angiographic stenoses. We conclude that chest pain during dipyridamole-thallium testing is not closely related to the severity of CAD and has little diagnostic value.
静脉注射双嘧达莫并进行铊显像可在不运动的情况下对冠状动脉疾病（CAD）进行负荷试验。双嘧达莫 - 铊试验时可能会出现胸痛，但其诊断意义尚不确定。我们确定了45例在双嘧达莫 - 铊试验期间接受冠状动脉造影、未进行血运重建且出现胸痛的患者。这些患者在性别和年龄上与45例接受冠状动脉造影、未进行血运重建且在双嘧达莫 - 铊试验期间未报告胸痛的患者进行了盲法匹配。在有胸痛和无胸痛的两组中，无CAD的患者分别为9%和24%，单支血管病变的患者分别为16%和16%，双支血管CAD的患者分别为38%和29%，三支血管CAD的患者分别为38%和29%。这些差异未达到统计学意义。此外，按血管或狭窄百分比划分的血管造影CAD严重程度也没有明显差异（p大于0.50）。仅与缺血性ST段改变有中度关联（40%对16%，p小于0.02）。伴有缺血性ST段改变的胸痛也未能预测血管造影狭窄的分布或严重程度有任何差异。我们得出结论，双嘧达莫 - 铊试验期间的胸痛与CAD的严重程度没有密切关系，诊断价值不大。
