对于检测左束支传导阻滞患者的冠状动脉疾病，腺苷铊-201优于运动铊-201。

Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block.

作者信息

O'Keefe J H, Bateman T M, Barnhart C S

机构信息

Cardiovascular Consultants, Inc., Kansas City, Missouri 64111.

出版信息

J Am Coll Cardiol. 1993 May;21(6):1332-8. doi: 10.1016/0735-1097(93)90305-k.

DOI:10.1016/0735-1097(93)90305-k

PMID:8473638

Abstract

OBJECTIVES

We sought to assess the comparative diagnostic accuracy of adenosine versus exercise in conjunction with thallium-201 scintigraphy for the detection and localization of coronary artery disease in patients with left bundle branch block on the rest electrocardiogram (ECG).

BACKGROUND

Patients with left bundle branch block on the rest ECG frequently have artifactual reversible septal perfusion defects on exercise thallium-201 scintigraphy. Adenosine thallium scintigraphy is a theoretically attractive alternative in these patients.

METHODS

One hundred seventy-three consecutive patients with left bundle branch block were evaluated with either exercise thallium (n = 56) or adenosine thallium (n = 117) scintigraphy. The tomographic thallium images were interpreted visually with adjunctive quantitative analysis. Follow-up cardiac catheterization was performed in 31 of the 56 patients in the exercise thallium group and 42 of the 117 patients in the adenosine thallium group.

RESULTS

Minor subjective side effects were noted in most patients in the adenosine thallium group (86%); atrioventricular block occurred in seven patients (6%). The overall predictive accuracy was 93% in the adenosine thallium group and 68% in the exercise thallium group (p = 0.01). The combined specificity for the detection of disease in the coronary arteries subtending the septum (the left anterior descending and right coronary arteries) was only 42% with exercise thallium scintigraphy versus 82% with adenosine thallium scintigraphy (p < 0.0002).

CONCLUSIONS

Adenosine thallium imaging 1) was superior to exercise thallium imaging in the detection of coronary artery disease in patients with left bundle branch block; 2) obviated septal artifacts, thereby markedly improving the specificity in the left anterior descending and right coronary arteries; and 3) was safe in patients with left bundle branch block.

摘要

目的

我们试图评估腺苷负荷试验与运动负荷试验联合铊 - 201心肌灌注显像在静息心电图（ECG）表现为左束支传导阻滞的患者中检测和定位冠状动脉疾病的相对诊断准确性。

背景

静息ECG表现为左束支传导阻滞的患者在运动铊 - 201心肌灌注显像时经常出现人为的可逆性室间隔灌注缺损。腺苷负荷心肌灌注显像在这些患者中是一种理论上有吸引力的替代方法。

方法

对173例连续的左束支传导阻滞患者进行了运动铊（n = 56）或腺苷铊（n = 117）心肌灌注显像评估。断层铊图像通过辅助定量分析进行视觉解读。运动铊组的56例患者中有31例、腺苷铊组的117例患者中有42例进行了后续的心脏导管检查。

结果

腺苷铊组大多数患者（86%）出现轻微的主观副作用；7例患者（6%）发生房室传导阻滞。腺苷铊组的总体预测准确性为93%，运动铊组为68%（p = 0.01）。运动铊心肌灌注显像检测室间隔下冠状动脉（左前降支和右冠状动脉）疾病的联合特异性仅为42%，而腺苷铊心肌灌注显像为82%（p < 0.0002）。