Ventosa A, Gil V, Seabra-Gomes R
Laboratório de Medicina Nuclear, Instituto do Coração.
Rev Port Cardiol. 1995 Feb;14(2):123-35, 104.
To review the experience of the laboratory on exercise-redistribution thalium-201 scintigraphy after myocardial infarction, and to compare scintigraphy results with those of exercise test and coronary angiography.
DESIGN/SETTING/PATIENTS: Retrospective analysis of data from scintigraphy, exercise test and coronary angiography from all patients evaluated after myocardial infarction at Nuclear Medicine Department of Instituto do Coração with treadmill exercise-redistribution thallium-201 SPECT, if they were also submitted to cardiac catheterization. These criteria were met by 185 patients, studied between March 1988 and July 1993.
Micro-Delta system with a Siemens Orbiter gamma camera. Visual analysis of intensity and reversibility of perfusion defects in 5 segments per patient, using oblique reconstruction of images.
Perfusion defects were found in 97% of patients and in 418/925 analysed segments. Variable degrees of reversibility were found in 78% of patients. On patients with single-vessel disease, vessel occlusion was associated with a slightly higher prevalence of reversibility (81% vs 71%; ns), and, for anterior infarcts, also with a higher prevalence of defects in areas supposed to be remote territories (44% vs 15%, p < 0.05). For 159 patients with a conclusive exercise test, ability of exercise test in diagnosing defects with reversibility was studied. Negative predictive accuracy of exercise test was poor (33%). Angina was 86% specific. Use of isolated ST depression, depression plus elevation or isolated ST elevation as criteria for a positive test result in a progressive improvement of sensitivity, but at cost of a decrease in specificity, more marked when using isolated ST elevation.
Thallium scintigraphy revealed perfusion defects with some degree of reversibility in a large number of patients studied after myocardial infarction, even when considering single-vessel disease or occluded infarct-related artery. Electrocardiographic treadmill exercise test had a poor negative predictive accuracy, being reasonably sensible in multivessel disease, but poorer in single vessel disease. After infarction, typical angina should probably be also considered as criterion for ischemia, regardless of electrocardiographic changes. In a perspective of eventual use of revascularization after infarction, thallium-201 scintigraphy is a valuable tool, and should probably be considered in most patients.
回顾心肌梗死后运动-再分布铊-201闪烁扫描的实验室经验，并将闪烁扫描结果与运动试验和冠状动脉造影结果进行比较。
设计/地点/患者：对巴西心脏研究所核医学科所有心肌梗死后接受评估的患者的闪烁扫描、运动试验和冠状动脉造影数据进行回顾性分析，这些患者均接受了跑步机运动-再分布铊-201单光子发射计算机断层扫描（SPECT），且也接受了心导管检查。1988年3月至1993年7月期间研究的185例患者符合这些标准。
使用配备西门子Orbiterγ相机的Micro-Delta系统。对每位患者的5个节段灌注缺损的强度和可逆性进行视觉分析，采用图像的斜位重建。
97%的患者及925个分析节段中的418个发现有灌注缺损。78%的患者发现有不同程度的可逆性。在单支血管病变患者中，血管闭塞与可逆性的患病率略高相关（81%对71%；无显著性差异），对于前壁梗死患者，在假定为远隔区域的缺损患病率也较高（44%对15%，p<0.05）。对159例运动试验结果明确的患者，研究了运动试验诊断可逆性缺损的能力。运动试验的阴性预测准确性较差（33%）。心绞痛的特异性为86%。将孤立性ST段压低、压低加抬高或孤立性ST段抬高作为阳性试验结果的标准，敏感性逐渐提高，但特异性降低，使用孤立性ST段抬高时更为明显。
铊闪烁扫描显示，在心肌梗死后研究的大量患者中存在一定程度可逆性的灌注缺损，即使考虑单支血管病变或梗死相关动脉闭塞。心电图跑步机运动试验的阴性预测准确性较差，在多支血管病变中较为敏感，但在单支血管病变中较差。梗死后，典型心绞痛可能也应被视为缺血的标准，无论心电图有无变化。从梗死后最终可能使用血运重建术的角度来看，铊-201闪烁扫描是一种有价值的工具，大多数患者可能都应考虑进行此项检查。
