冠心病的检测：锝99m标记的甲氧基异丁基异腈单光子发射计算机断层扫描与二维超声心动图联合双嘧达莫低水平运动负荷试验的比较

Detection of coronary artery disease: comparison between technetium 99m-labeled sestamibi single-photon emission computed tomography and two-dimensional echocardiography with dipyridamole low-level exercise-stress.

作者信息

Cramer M J, van der Wall E E, Jaarsma W, Verzijlbergen J F, Niemeyer M G, Zwinderman A H, Pauwels E K

机构信息

Department of Cardiology, St. Antonius Hospital, Niewegein, The Netherlands.

出版信息

J Nucl Cardiol. 1996 Sep-Oct;3(5):389-94. doi: 10.1016/s1071-3581(96)90073-2.

DOI:10.1016/s1071-3581(96)90073-2

PMID:8902670

Abstract

BACKGROUND

Myocardial perfusion imaging in conjunction with dipyridamole low-level exercise stress has proved its value in the evaluation of patients with coronary artery disease (CAD). Simultaneous wall motion analysis by two-dimensional (2D) echocardiography may provide additional information beyond that obtained by myocardial perfusion imaging alone. The purpose of this study was to compare 99mTc-labeled sestamibi single-photon emission computed tomography (SPECT) and 2D echocardiography for the evaluation of CAD according to a dipyridamole low-level bicycle exercise stress protocol.

METHODS AND RESULTS

We studied 35 consecutive patients referred for the evaluation of chest pain who had undergone coronary arteriography. 99mTc-labeled sestamibi SPECT and 2D echocardiography agreed in 27 patients (80%) studied for overall detection of CAD. On a segmental basis, agreement was found between SPECT and 2D echocardiography in 124 (73%) of 170 segments (Cohen's kappa = 0.43). The accuracy of the combined assessment of myocardial perfusion and echocardiographic wall motion in detecting CAD was 86%, which was not different from the accuracy of SPECT alone (80%; difference not significant) but significantly higher than for 2D echocardiography alone (71%; p = 0.03). In the detection of individual coronary artery stenoses, SPECT had a significantly higher accuracy for detecting left anterior descending coronary artery lesions than had 2D echocardiography (80% vs 60%; p < 0.01); combining the two method did not improve the accuracy (80%). The combined assessment slightly improved the accuracy for detecting left circumflex coronary artery stenoses from 71% to 83% (p = 0.05).

CONCLUSION

The combined simultaneous assessment of myocardial perfusion by 99mTc-labeled sestamibi SPECT and wall motion by 2D echocardiography did not significantly improve overall accuracy over that obtained by 99mTc-labeled sestamibi SPECT alone. Therefore 99mTc-labeled sestamibi SPECT with dipyridamole low-level exercise stress appears the preferred imaging modality for the evaluation of patients with CAD.

摘要

背景

双嘧达莫低水平运动负荷下的心肌灌注成像已在冠状动脉疾病（CAD）患者评估中证明其价值。二维（2D）超声心动图同步进行壁运动分析可能提供超出单纯心肌灌注成像所获得的额外信息。本研究的目的是根据双嘧达莫低水平自行车运动负荷方案，比较99mTc标记的甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）和2D超声心动图在评估CAD方面的效果。

方法与结果

我们研究了35例因胸痛接受冠状动脉造影的连续患者。在对CAD进行总体检测的研究中，99mTc标记的甲氧基异丁基异腈SPECT和2D超声心动图在27例患者（80%）中结果一致。在节段基础上，SPECT和2D超声心动图在170个节段中的124个（73%）结果一致（科恩kappa系数 = 0.43）。心肌灌注和超声心动图壁运动联合评估检测CAD的准确性为86%，与单独SPECT的准确性（80%；差异不显著）无差异，但显著高于单独2D超声心动图的准确性（71%；p = 0.03）。在检测单个冠状动脉狭窄方面，SPECT检测左前降支冠状动脉病变的准确性显著高于2D超声心动图（80%对60%；p < 0.01）；两种方法联合并未提高准确性（80%）。联合评估将检测左旋支冠状动脉狭窄的准确性从71%略微提高到83%（p = 0.05）。