比较高剂量双嘧达莫单光子发射计算机断层扫描成像方案与多巴酚丁胺及运动负荷试验方案。

Comparing a high-dose dipyridamole SPECT imaging protocol with dobutamine and exercise stress testing protocols.

作者信息

Fleming R M, Rose C H, Feldmann K M

机构信息

Center for Clinical Cardiology and Research, Cedar Rapids, Iowa, USA.

出版信息

Angiology. 1995 Jul;46(7):547-56. doi: 10.1177/000331979504600701.

DOI:10.1177/000331979504600701

PMID:7618757

Abstract

OBJECTIVE

To determine the safety, sensitivity, specificity, and accuracy of high-dose dipyridamole compared with treadmill and dobutamine stress imaging protocols.

BACKGROUND

Nuclear imaging studies using standard dose dipyridamole provide similar results to those obtained when treadmill stress is used. Recently dobutamine tomography and planar imaging with high-dose dipyridamole have been shown no improve nuclear imaging results.

METHODS

One hundred fifty-nine patients were imaged with thallium, teboroxime, or sestamibi per standard single photon emission computed tomography (SPECT) protocols. Pharmacologic stress was performed in 85 people with the remainder undergoing exercise testing by Bruce protocol. In this study, 0.852 mg dipyridamole was used per kilogram body weight and was infused over a four-minute period. Results from nuclear imaging were compared with those from coronary arteriograms.

RESULTS

The sensitivity and specificity of high-dose dipyridamole was 100% and 88.9%, respectively, which is statistically greater (P < 0.005) than that achieved when patients were stressed by treadmill. Side effects with the higher dose of dipyridamole were easily reversed with aminophylline. The sensitivity and specificity of intravenous dobutamine was 100%, but it was used in a limited number of subjects. When patients were stressed by Bruce protocol the sensitivity was 92.5% and specificity was 42.8%. The differences were not attributable to inadequate exercise duration.

CONCLUSIONS

High-dose dipyridamole is safe and easily reversed with intravenous aminophylline. The sensitivity and specificity of dipyridamole and dobutamine stress testing were statistically more accurate than results obtained with treadmill protocols when SPECT is used to image the heart. High-dose dipyridamole resulted in greater changes in heart rate and blood pressure response than seen with standard-dose dipyridamole. Associated side effects can be easily reversed with the administration of intravenous aminophylline without significant complications. The sensitivity, specificity, and accuracy of single photon emission computed tomography using high-dose dipyridamole are 100%, 88.9%, and 97.9%, respectively, for the overall presence or absence of disease when compared with coronary arteriography. This is significantly (P < 0.005) greater than that obtained by treadmill nuclear imaging protocols, independent imaging agent.

摘要

目的

确定与跑步机及多巴酚丁胺负荷成像方案相比，大剂量双嘧达莫的安全性、敏感性、特异性及准确性。

背景

使用标准剂量双嘧达莫的核成像研究结果与使用跑步机负荷试验时相似。最近研究表明，多巴酚丁胺断层扫描及大剂量双嘧达莫平面成像并未改善核成像结果。

方法

159例患者按照标准单光子发射计算机断层扫描（SPECT）方案，使用铊、替硼酸肟或甲氧基异丁基异腈进行成像。85例患者进行药物负荷试验，其余患者按照布鲁斯方案进行运动试验。本研究中，每千克体重使用0.852毫克双嘧达莫，并在4分钟内静脉输注。将核成像结果与冠状动脉造影结果进行比较。

结果

大剂量双嘧达莫的敏感性和特异性分别为100%和88.9%，在统计学上显著高于（P < 0.005）患者进行跑步机负荷试验时的结果。较高剂量双嘧达莫的副作用可通过氨茶碱轻松逆转。静脉注射多巴酚丁胺的敏感性和特异性为100%，但使用的受试者数量有限。当患者按照布鲁斯方案进行负荷试验时，敏感性为92.5%，特异性为42.8%。差异并非归因于运动持续时间不足。

结论

大剂量双嘧达莫安全，且静脉注射氨茶碱可轻松逆转其作用。当使用SPECT对心脏进行成像时，双嘧达莫和多巴酚丁胺负荷试验的敏感性和特异性在统计学上比跑步机方案获得的结果更准确。与标准剂量双嘧达莫相比，大剂量双嘧达莫导致心率和血压反应变化更大。静脉注射氨茶碱可轻松逆转相关副作用，且无明显并发症。与冠状动脉造影相比，使用大剂量双嘧达莫的单光子发射计算机断层扫描对于疾病总体存在与否的敏感性、特异性和准确性分别为100%、88.9%和97.9%。这在统计学上显著高于（P < 0.005）跑步机核成像方案及独立成像剂获得的结果。