Marie P Y, Danchin N, Durand J F, Feldmann L, Grentzinger A, Olivier P, Karcher G, Juillière Y, Virion J M, Beurrier D
Service de Médecine Nucléaire, CHU Nancy-Brabois, France.
J Am Coll Cardiol. 1995 Oct;26(4):879-86. doi: 10.1016/0735-1097(95)00243-9.
This study sought to evaluate the prognostic role of exercise thallium-201 (Tl-201) single-photon emission computed tomography (SPECT) in patients with known or suspected coronary artery disease.
Compared with planar Tl-201 scintigraphy, Tl-201 SPECT allows enhanced assessment of myocardial perfusion abnormalities. However, the long-term prognostic value of exercise Tl-201 SPECT has not been ascertained and compared with that of other techniques of investigation.
Predictors of ischemic events were sought in 217 patients with known or suspected coronary artery disease who underwent exercise Tl-201 SPECT, coronary angiography and rest radionuclide angiography and who initially received medical therapy. Predictive values were determined using Cox proportional hazards regression models.
During a mean (+/- SD) follow-up period of 70 +/- 19 months, 29 patients had a major ischemic event (cardiac death or myocardial infarction). Total extent of exercise defects was the best independent predictor by Tl-201 SPECT of major events (p < 0.001) and provided additional prognostic information compared with clinical, exercise testing and catheterization variables (p < 0.02). Extent of reversible Tl-201 SPECT perfusion defects provided additional prognostic information compared with extent of irreversible defects (p < 0.001) and was the sole Tl-201 SPECT variable providing additional prognostic information compared with radionuclide left ventricular ejection fraction (p < 0.02).
Total extent of exercise Tl-201 SPECT defects is a powerful long-term predictor of major ischemic events that enhances the prediction provided by clinical, exercise testing and coronary angiographic data. In view of its prognostic significance, extent of reversible Tl-201 SPECT defects might provide original information about improving prognosis by coronary revascularization.
本研究旨在评估运动铊-201（Tl-201）单光子发射计算机断层扫描（SPECT）在已知或疑似冠心病患者中的预后作用。
与平面Tl-201闪烁扫描相比，Tl-201 SPECT能够更好地评估心肌灌注异常。然而，运动Tl-201 SPECT的长期预后价值尚未确定，也未与其他检查技术进行比较。
在217例已知或疑似冠心病且接受运动Tl-201 SPECT、冠状动脉造影和静息放射性核素血管造影并最初接受药物治疗的患者中寻找缺血事件的预测因素。使用Cox比例风险回归模型确定预测值。
在平均（±标准差）70±19个月的随访期内，29例患者发生了重大缺血事件（心源性死亡或心肌梗死）。运动缺陷的总范围是Tl-201 SPECT预测重大事件的最佳独立预测因素（p<0.001），与临床、运动试验和导管检查变量相比，提供了额外的预后信息（p<0.02）。与不可逆缺陷范围相比，可逆性Tl-201 SPECT灌注缺陷范围提供了额外的预后信息（p<0.001），并且是与放射性核素左心室射血分数相比提供额外预后信息的唯一Tl-201 SPECT变量（p<0.02）。
运动Tl-201 SPECT缺陷的总范围是重大缺血事件的有力长期预测因素，可增强临床、运动试验和冠状动脉造影数据所提供的预测。鉴于其预后意义，可逆性Tl-201 SPECT缺陷范围可能为通过冠状动脉血运重建改善预后提供原始信息。
