Bax J J, Cornel J H, Visser F C, Fioretti P M, van Lingen A, Reijs A E, Boersma E, Teule G J, Visser C A
Department of Cardiology, Free University Hospital Amsterdam, The Netherlands.
J Am Coll Cardiol. 1996 Sep;28(3):558-64. doi: 10.1016/0735-1097(96)00222-7.
We compared three techniques to predict functional recovery after revascularization.
Recently, fluorine-18 (F-18) fluorodeoxyglucose in combination with single-photon emission computed tomography (SPECT) has been proposed to identify viable myocardium, Thallium-201 reinjection and low dose dobutamine echocardiography are used routinely for this purpose.
Seventeen patients (mean [+/- SD] left ventricular ejection fraction 36 +/- 11%) were studied. Regional and global ventricular function were evaluated before and 3 months after revascularization by echocardiography and radionuclide ventriculography, respectively. Myocardial F-18 fluorodeoxyglucose uptake (during hyperinsulinemic glucose clamping) was compared with rest perfusion assessed with early thallium-201 SPECT. On a separate day, low dose dobutamine echocardiography and post-stress thallium-201 reinjection SPECT were simultaneously performed.
The sensitivities for F-18 fluorodeoxyglucose/thallium-201, thallium-201 reinjection and low dose dobutamine echocardiography to assess recovery were 89%, 93% and 85%, respectively; specificities were 77%, 43% and 63%, respectively. Stepwise logistic regression indicated that F-18 fluorodeoxyglucose/ thallium-201 was the best predictor. In hypokinetic segments, the combination of F-18 fluorodeoxyglucose/thallium-201 and low dose dobutamine echocardiography was the best predictor. Global function improved (left ventricular ejection fraction increased > 5%) in 6 patients and remained unchanged in 11. All three techniques correctly identified five of six patients with improvement. Fluorine-18 fluorodeoxyglucose/thallium-201 identified all patients without improvement; low dose dobutamine echocardiography identified 9 of 11 without improvement; and thallium-201 reinjection identified 6 of 11 patients without improvement.
Fluorine-18 fluorodeoxyglucose/thallium-201 SPECT was superior to the other techniques in assessing functional recovery. Integration of metabolic and functional data is necessary, particularly in hypokinesia, for optimal prediction of improvement of regional function.
我们比较了三种预测血管重建术后功能恢复的技术。
最近，有人提出将氟-18（F-18）氟脱氧葡萄糖与单光子发射计算机断层扫描（SPECT）相结合来识别存活心肌，铊-201再注射和低剂量多巴酚丁胺超声心动图通常用于此目的。
对17例患者（平均[±标准差]左心室射血分数36±11%）进行了研究。分别通过超声心动图和放射性核素心室造影术评估血管重建术前和术后3个月的局部和整体心室功能。将心肌F-18氟脱氧葡萄糖摄取（在高胰岛素血糖钳夹期间）与用早期铊-201 SPECT评估的静息灌注进行比较。在另一天，同时进行低剂量多巴酚丁胺超声心动图和负荷后铊-201再注射SPECT。
F-18氟脱氧葡萄糖/铊-201、铊-201再注射和低剂量多巴酚丁胺超声心动图评估恢复情况的敏感性分别为89%、93%和85%；特异性分别为77%、43%和63%。逐步逻辑回归表明，F-18氟脱氧葡萄糖/铊-201是最佳预测指标。在运动减弱节段，F-18氟脱氧葡萄糖/铊-201与低剂量多巴酚丁胺超声心动图的联合是最佳预测指标。6例患者的整体功能改善（左心室射血分数增加>5%），11例患者保持不变。所有三种技术都正确识别出6例改善患者中的5例。F-18氟脱氧葡萄糖/铊-201识别出所有未改善的患者；低剂量多巴酚丁胺超声心动图识别出11例未改善患者中的9例；铊-201再注射识别出11例未改善患者中的6例。
F-18氟脱氧葡萄糖/铊-201 SPECT在评估功能恢复方面优于其他技术。整合代谢和功能数据是必要的，特别是在运动减退时，以最佳预测局部功能的改善。
