Szmigielski Cezary A, Sabharwal Nikant, Newton James D, Becher Harald
Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Department of Internal Medicine Hypertension and Vascular Diseases, Medical University of Warsaw, UCK CSK, 1A Banacha Street, Warsaw, 02-097, Poland.
Int J Cardiovasc Imaging. 2024 Dec;40(12):2513-2521. doi: 10.1007/s10554-024-03257-x. Epub 2024 Oct 12.
We aimed to evaluate an approach with resting echocardiography (TTE) and stress myocardial perfusion scintigraphy (MPS) compared to standard MPS in patients with stable angina and normal left ventricle (LV). We hypothesized that normal LV on TTE may allow for the elimination of rest MPS without compromising accuracy and offering an efficient diagnostic pathway with reduced radiation exposure.
In a prospective, non-randomized study TTE was performed prior to MPS in patients (pts) referred for assessment of coronary artery disease (CAD). In pts with normal LV assessment was performed using the hybrid and the standard approach. TTE and MPS were interpreted by two TTE readers (ER1-2) and two MPS readers (NR1-2). ECHO-MPS was compared with standard MPS for diagnostic accuracy.
103 patients, mean age 61 ± 12 year, (63 M, 40 W) were recruited. Standard MPS were normal in 75 patients and abnormal in 28 patients, with the hybrid approach 79 studies were reported as normal and 24 studies as abnormal. Kappa values were 0.580, (p < 0.001) for large, 0.394, (p < 0.001) for medium, and 0.298 (p = 0.002) for small defects. With standard MPS as a reference, sensitivity for detection of perfusion defects by ECHO-MPS was 75% (95% CI 0.67-0.83) [NR2] and 78% (95% CI 0.70-0.86)[NR1]. Specificity was 95% (95% CI 0.90-0.99) [NR2] and 95% (CI 95%CI 0.90-0.99) [NR1].
ECHO-MPS protocol provides similar diagnostic accuracy as standard stress-rest MPS. In patients with normal systolic LV function in TTE, performing only stress MPS provides similar information as standard rest and stress MPS.
我们旨在评估一种针对稳定型心绞痛且左心室（LV）正常的患者，采用静息超声心动图（TTE）和负荷心肌灌注闪烁显像（MPS）的方法，并与标准MPS进行比较。我们假设TTE显示LV正常的患者可以省略静息MPS，而不会影响准确性，并且能提供一种减少辐射暴露的高效诊断途径。
在一项前瞻性、非随机研究中，对因评估冠状动脉疾病（CAD）而转诊的患者，在进行MPS之前先进行TTE检查。对于LV正常的患者，采用联合方法和标准方法进行评估。TTE和MPS分别由两名TTE阅片者（ER1-2）和两名MPS阅片者（NR1-2）解读。将超声心动图-心肌灌注闪烁显像（ECHO-MPS）与标准MPS的诊断准确性进行比较。
共招募了103例患者，平均年龄61±12岁（63例男性，40例女性）。标准MPS检查中，75例患者结果正常，28例患者异常；联合方法检查中，79项结果报告为正常，24项结果报告为异常。对于大缺损，kappa值为0.580（p<0.001）；对于中等缺损，kappa值为0.394（p<0.001）；对于小缺损，kappa值为0.298（p = 0.002）。以标准MPS为参考，ECHO-MPS检测灌注缺损的敏感性为75%（95%CI 0.67-0.83）[NR2]和78%（95%CI 0.70-0.86）[NR1]。特异性为95%（95%CI 0.90-0.99）[NR2]和95%（CI 95%CI 0.90-0.99）[NR1]。
ECHO-MPS方案提供了与标准负荷-静息MPS相似的诊断准确性。在TTE检查中收缩期LV功能正常的患者中，仅进行负荷MPS检查可提供与标准静息和负荷MPS检查相似的信息。
