Iftikhar I, Koutelou M, Mahmarian J J, Verani M S
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
J Nucl Med. 1996 Aug;37(8):1306-10.
The purpose of this investigation was to evaluate the changes in left ventricular function and volumes concurrently with tomographic myocardial perfusion during dobutamine infusion.
Ninety-two patients underwent first-pass radionuclide angiography using a multicrystal gamma camera and myocardial tomography after high-dose (40 micrograms/kg/min) dobutamine infusion and 99mTc-sestamibi administration.
Dobutamine increased systolic blood pressure (p < 0.0001), heart rate (p < 0.00017), left ventricular ejection fraction (p = 0.0001), cardiac output (p = 0.0001) and stroke volume (p = 0.042). The end-diastolic (p = 0.009) and end-systolic volumes (p = 0.0007) significantly decreased. Of 38 patients with cardiac catheterization, 28 had significant coronary artery disease and 10 had normal coronaries. The sensitivity and specificity for coronary artery disease detection by myocardial perfusion tomography were 78% and 90%, respectively. By radionuclide angiography, only 9 of 27 coronary artery disease patients experienced deterioration of wall motion during dobutamine (sensitivity 33%).
Changes in myocardial perfusion are more sensitive than changes in left ventricular function for detecting coronary artery disease during dobutamine stress.
本研究的目的是评估多巴酚丁胺输注期间左心室功能和容积的变化以及断层心肌灌注情况。
92例患者在大剂量（40微克/千克/分钟）多巴酚丁胺输注及注射99m锝-甲氧基异丁基异腈后，使用多晶体γ相机进行首次通过放射性核素血管造影和心肌断层扫描。
多巴酚丁胺使收缩压（p < 0.0001）、心率（p < 0.00017）、左心室射血分数（p = 0.0001）、心输出量（p = 0.0001）和每搏输出量（p = 0.042）增加。舒张末期容积（p = 0.009）和收缩末期容积（p = 0.0007）显著降低。在38例接受心导管检查的患者中，28例有显著冠状动脉疾病，10例冠状动脉正常。心肌灌注断层扫描检测冠状动脉疾病的敏感性和特异性分别为78%和90%。通过放射性核素血管造影，27例冠状动脉疾病患者中只有9例在多巴酚丁胺输注期间出现壁运动恶化（敏感性33%）。
在多巴酚丁胺负荷试验期间，心肌灌注变化在检测冠状动脉疾病方面比左心室功能变化更敏感。
