Huikuri H V, Ikäheimo M J, Korhonen U R, Heikkilä J, Takkunen J T
Division of Cardiology, Oulu University Central Hospital, Finland.
Acta Med Scand. 1987;222(4):311-8. doi: 10.1111/j.0954-6820.1987.tb10677.x.
To evaluate thallium scintigraphy in predicting coronary artery bypass graft patency, exercise thallium scintigraphy and selective graft and native vessel angiograms were performed in 22 asymptomatic and 29 symptomatic consecutive patients three months after coronary artery bypass grafting (CABG). Twelve out of 22 asymptomatic patients (55%) had reversible thallium defects on postoperative images; in 10 patients the postoperative scans were normal. The graft patency was significantly lower in asymptomatic patients with abnormal thallium perfusion compared to those with normal perfusion after CABG (68% vs. 91%, p less than 0.05). The rate of graft patency in symptomatic patients was 66/87 (76%). Thallium scintigraphy was 77% sensitive and 78% specific in detecting one or more stenosed or occluded bypass grafts in patients without angina (accuracy 77%). When data from exercise electrocardiography were combined with scintigraphy, all but one patient with incomplete revascularization could be detected (positive predictive accuracy 92%). In symptomatic patients, thallium scintigraphy accurately predicted the presence or absence of graft occlusion in 24/29 (83%) cases. Thus, abnormal myocardial perfusion due to stenosis or occlusion of bypass grafts is common in both asymptomatic and symptomatic patients after CABG. Thallium scintigraphy together with exercise electrocardiography appear to be useful non-invasive methods in detecting painless myocardial ischemia and in predicting bypass graft occlusion after CABG.
为评估铊闪烁扫描术预测冠状动脉旁路移植血管通畅情况的能力，对22例无症状和29例有症状的连续患者在冠状动脉旁路移植术（CABG）后三个月进行了运动铊闪烁扫描术以及选择性移植血管和自身血管造影。22例无症状患者中有12例（55%）术后图像出现可逆性铊缺损；10例患者术后扫描正常。与CABG后灌注正常的无症状患者相比，铊灌注异常的无症状患者移植血管通畅率显著降低（68%对91%，p小于0.05）。有症状患者的移植血管通畅率为66/87（76%）。在无心绞痛患者中，铊闪烁扫描术检测一处或多处狭窄或闭塞的旁路移植血管时，敏感性为77%，特异性为78%（准确性77%）。当将运动心电图数据与闪烁扫描术相结合时，除1例血运重建不完全的患者外，其余所有患者均可被检测到（阳性预测准确性92%）。在有症状患者中，铊闪烁扫描术在24/29（83%）的病例中准确预测了移植血管闭塞的存在与否。因此，CABG后无症状和有症状患者中，旁路移植血管狭窄或闭塞导致的心肌灌注异常均很常见。铊闪烁扫描术与运动心电图似乎是检测无痛性心肌缺血以及预测CABG后旁路移植血管闭塞的有用无创方法。
