Lette J, Bertrand C, Gossard D, Ruscito O, Cerino M, McNamara D, Picard M, Eybalin M C, Levasseur A, Nattel S
Maisonneuve Hospital, Montréal, Québec, Canada.
Am Heart J. 1995 May;129(5):880-6. doi: 10.1016/0002-8703(95)90107-8.
This study was undertaken to assess the reliability of clinical parameters and dipyridamole-thallium 201 images for predicting the occurrence of future cardiac events (nonfatal myocardial infarction or cardiac death). Dipyridamole myocardial perfusion imaging is routinely performed in patients who have possible or known coronary disease and a low exercise tolerance. A total of 753 patients underwent clinical assessment and semiquantitative dipyridamole-201TI imaging and were followed up as outpatients. Patients who underwent coronary revascularization during the follow-up period were excluded from the study because the decision to intervene would have been based at least in part on the test itself. There were 82 cardiac events and 54 noncardiac deaths, and 11 patients were lost to follow-up after a mean follow-up of 15 months. With use of a quantitative index reflecting the amount of jeopardized myocardium, patients could be stratified by dipyridamole imaging into subsets with coronary morbidity and mortality rates ranging from 1% to 89%, (p = 0.0001). When clinical and scintigraphic variables were subjected to backward stepwise logistic regression analysis, the significant predictors of cardiac events were the jeopardized myocardium index by scintigraphy (p < 0.0001), left ventricular hypertrophy on the electrocardiogram (p = 0.0009), and transient dipyridamole-induced left ventricular cavitary dilatation (p = 0.0073). Quantitative dipyridamole-201TI imaging appears to be a powerful predictor of future cardiac events in patients with coronary disease and a low exercise tolerance and is a potentially useful contributor to risk-profile assessment and to the treatment of these patients.
本研究旨在评估临床参数和双嘧达莫 - 铊 - 201图像预测未来心脏事件（非致命性心肌梗死或心源性死亡）发生的可靠性。对于可能患有或已知患有冠状动脉疾病且运动耐量低的患者，常规进行双嘧达莫心肌灌注成像。共有753例患者接受了临床评估和双嘧达莫 - 201铊半定量成像，并作为门诊患者进行随访。随访期间接受冠状动脉血运重建的患者被排除在研究之外，因为干预决定至少部分基于检查本身。发生了82例心脏事件和54例非心脏死亡，平均随访15个月后有11例患者失访。使用反映心肌受损量的定量指标，通过双嘧达莫成像可将患者分层为冠状动脉发病率和死亡率从1%至89%不等的亚组（p = 0.0001）。当对临床和闪烁扫描变量进行向后逐步逻辑回归分析时，心脏事件的显著预测因素是闪烁扫描的心肌受损指数（p < 0.0001）、心电图上的左心室肥厚（p = 0.0009）以及双嘧达莫诱导的短暂性左心室腔扩张（p = 0.0073）。定量双嘧达莫 - 201铊成像似乎是冠状动脉疾病且运动耐量低的患者未来心脏事件的有力预测指标，并且对这些患者的风险评估和治疗可能是一个有用的贡献因素。
