Darbar D, Gillespie N, Main G, Bridges A B, Kennedy N S, Pringle T H, McNeill G P
Department of Cardiology, Ninewells Hospital and Medical School, Dundee, Scotland.
Am J Cardiol. 1996 Oct 1;78(7):736-40. doi: 10.1016/s0002-9149(96)00412-2.
Concomitant coronary artery disease often occurs in patients with peripheral vascular disease, but it may be asymptomatic. Despite being asymptomatic, cardiovascular events are the main source of morbidity and mortality in this group of patients. Dipyridamole thallium scintigraphy has been shown to be of prognostic value in patients with peripheral vascular disease and symptomatic coronary artery disease, but its effect on the long-term outcome in the asymptomatic group of patients is less defined. Eighty-four consecutive patients with peripheral vascular disease and no symptoms of coronary artery disease were therefore evaluated by clinical assessment, dipyridamole thallium imaging, radionuclide ventriculography, and cardiac catheterization and followed for a mean of 66 months. Abnormal perfusion patterns were found on thallium scintigraphy in 48 patients (57%); fixed, mixed, and reversible defects were present in 14 (17%), 11 (13%), and 23 (27%) patients, respectively. Significant coronary artery disease was present in 52 patients (69%) and mean left ventricular ejection fraction was 44%. During the follow-up period, 23 patients had a cardiac event (nonfatal myocardial infarction or cardiac death). Univariate analysis of 15 clinical, scintigraphic, radionuclide, and angiographic variables revealed that age, angiographic extent of coronary artery disease, and an abnormal thallium scan were significant predictors of subsequent cardiac events. Multivariate stepwise logistic regression analyses selected fixed and mixed thallium defects and diffuse coronary artery disease as the only significant independent predictors of outcome. Thus, the present study shows the value of dipyridamole thallium scintigraphy as a valuable prognostic indicator for long-term event-free survival in a cohort of patients with peripheral vascular disease and no history or symptoms of coronary artery disease.
冠状动脉疾病常发生于外周血管疾病患者中，但可能无症状。尽管无症状，但心血管事件是这类患者发病和死亡的主要原因。双嘧达莫铊闪烁扫描已被证明对患有外周血管疾病和有症状的冠状动脉疾病患者具有预后价值，但其对无症状患者长期预后的影响尚不明确。因此，对84例连续的外周血管疾病且无冠状动脉疾病症状的患者进行了临床评估、双嘧达莫铊显像、放射性核素心室造影和心导管检查，并平均随访66个月。48例患者（57%）铊闪烁扫描发现灌注模式异常；14例（17%）、11例（13%）和23例（27%）患者分别存在固定、混合和可逆性缺损。52例患者（69%）存在显著冠状动脉疾病，平均左心室射血分数为44%。在随访期间，23例患者发生了心脏事件（非致命性心肌梗死或心源性死亡）。对15项临床、闪烁扫描、放射性核素和血管造影变量进行单因素分析显示，年龄、冠状动脉疾病的血管造影范围和铊扫描异常是随后心脏事件的显著预测因素。多因素逐步逻辑回归分析选择固定和混合铊缺损以及弥漫性冠状动脉疾病作为唯一显著的独立预后预测因素。因此，本研究表明双嘧达莫铊闪烁扫描作为外周血管疾病且无冠状动脉疾病病史或症状患者长期无事件生存的有价值预后指标的价值。
