Lam J Y, Chaitman B R, Glaenzer M, Byers S, Fite J, Shah Y, Goodgold H, Samuels L
Department of Medicine, St. Louis, University School of Medicine, Missouri 63104.
J Am Coll Cardiol. 1988 Mar;11(3):585-9. doi: 10.1016/0735-1097(88)91535-5.
The noninvasive diagnosis of coronary artery disease in the elderly can occasionally be difficult. Intravenous dipyridamole-thallium imaging is a potentially useful diagnostic test to determine presence and severity of coronary disease; however, the safety of the procedure has not been determined in an older population. The side effect profile and frequency of severe ischemic responses after 0.56 mg/kg of intravenous dipyridamole were compared in 101 patients greater than or equal to 70 years old and 236 patients less than 70 years old. There were no side effects in 64% and 62% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). Among the 337 patients tested, there were no complications of myocardial infarction or death. The most common cardiac side effect was chest pain, which occurred in 21 (21%) of the 101 patients aged greater than or equal to 70 years and in 64 (27%) of the 236 patients less than 70 years (p = NS). Aminophylline was required to reverse cardiac or noncardiac side effects in 15 (15%) and 36 (15%) of the patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). A severe ischemic response occurred in 2% and 2.5% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). The sensitivity of intravenous dipyridamole-thallium imaging for obstructive coronary artery disease was 86% (25 of 29) and 83% (68 of 82) in older and younger patients, respectively (p = NS); the specificity was 75% (6 of 8) and 70% (16 of 23), respectively (p = NS). Thus, intravenous dipyridamole-thallium imaging is a safe noninvasive method for assessment of older patients with obstructive coronary disease; its side effect profile and diagnostic accuracy are similar to those seen in younger patients. The technique is associated with severe ischemic responses in only a small minority of patients.
老年人冠状动脉疾病的无创诊断有时会很困难。静脉注射双嘧达莫 - 铊显像术是一种用于确定冠状动脉疾病的存在和严重程度的潜在有用诊断测试；然而，该检查方法在老年人群中的安全性尚未确定。对101例年龄大于或等于70岁的患者和236例年龄小于70岁的患者进行了比较，观察静脉注射0.56mg/kg双嘧达莫后副作用情况及严重缺血反应的发生率。年龄大于或等于70岁和小于70岁的患者中分别有64%和62%未出现副作用（p = 无显著性差异）。在接受检查的337例患者中，未发生心肌梗死或死亡并发症。最常见的心脏副作用是胸痛，在101例年龄大于或等于70岁的患者中有21例（21%）出现，在236例年龄小于70岁的患者中有64例（27%）出现（p = 无显著性差异）。年龄大于或等于70岁和小于70岁的患者中分别有15例（15%）和36例（15%）需要使用氨茶碱来逆转心脏或非心脏副作用（p = 无显著性差异）。年龄大于或等于70岁和小于70岁的患者中分别有2%和2.5%出现严重缺血反应（p = 无显著性差异）。静脉注射双嘧达莫 - 铊显像术对老年和年轻患者中阻塞性冠状动脉疾病的敏感性分别为86%（29例中的25例）和83%（82例中的68例）（p = 无显著性差异）；特异性分别为75%（8例中的6例）和70%（23例中的16例）（p = 无显著性差异）。因此，静脉注射双嘧达莫 - 铊显像术是评估老年阻塞性冠状动脉疾病患者的一种安全无创方法；其副作用情况和诊断准确性与年轻患者相似。该技术仅在少数患者中会引发严重缺血反应。
