Senior R, Raval U, Lahiri A
Northwick Park Hospital and Institute of Medical Research, Harrow, Middlesex, United Kingdom.
Am J Cardiol. 1996 Nov 15;78(10):1092-6.
Inotropic stress using graded dobutamine infusion has evolved as an alternative form of pharmacologic stress in conjunction with perfusion and functional imaging for evaluation of coronary heart disease. However, the prognostic value of technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging in patients undergoing dobutamine stress testing for the detection of coronary artery disease is unclear. Accordingly, 61 patients undergoing coronary arteriography for the evaluation of chest pain on the basis of symptoms and treadmill exercise electrocardiography underwent SPECT imaging at rest and during stress. Patients were followed up for 19 +/- 11 months (2 to 33) during which 2 died, 2 had acute myocardial infarction, 13 developed unstable angina, and 3 had congestive heart failure. Univariate Cox regression analysis revealed that those with reversible defects (95%) and defects in multiple vascular territories (80%) on SPECT had a greater number of cardiac events compared to those without (59% [p = 0.02] and 34% [p = 0.002], respectively). The number of reversible (3.9 +/- 2.1) and fixed (2.3 +/- 2.0) segments (12-segment model) were greater in patients with cardiac events compared to those without, (2.3 +/- 2.5, p = 0.009 and 1.1 +/- 2.0, p = 0.02) respectively. When multivariate analysis was performed using clinical, exercise testing, and SPECT variables, the independent predictors of cardiac events were a history of myocardial infarction (p <0.001), number of reversible segments (p = 0.001), and presence of defects in multiple vascular territories (p = 0.01). In summary, dobutamine stress Tc-99m sestamibi SPECT is a powerful predictor of future cardiac events in patients undergoing coronary arteriography for evaluation of chest pain and may be used to stratify patients for further intervention.
使用递增剂量多巴酚丁胺输注的变力性负荷已发展成为一种与灌注和功能成像相结合的药理学负荷替代形式，用于评估冠心病。然而，锝-99m（Tc-99m）甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）成像在接受多巴酚丁胺负荷试验以检测冠状动脉疾病的患者中的预后价值尚不清楚。因此，61例因症状和运动平板心电图而接受冠状动脉造影以评估胸痛的患者在静息和负荷状态下接受了SPECT成像。患者随访19±11个月（2至33个月），在此期间2例死亡，2例发生急性心肌梗死，13例发生不稳定型心绞痛，3例发生充血性心力衰竭。单因素Cox回归分析显示，与无可逆性缺损（59%[p = 0.02]）和多血管区域缺损（34%[p = 0.002]）的患者相比，SPECT上有可逆性缺损（95%）和多血管区域缺损（80%）的患者发生心脏事件的数量更多。与无心脏事件的患者相比，有心脏事件的患者可逆节段（3.9±2.1）和固定节段（2.3±2.0）（12节段模型）的数量更多，分别为（2.3±2.5，p = 0.009和1.1±2.0，p = 0.02）。当使用临床、运动试验和SPECT变量进行多因素分析时，心脏事件的独立预测因素是心肌梗死病史（p <0.001）、可逆节段数量（p = 0.001）和多血管区域缺损的存在（p = 0.01）。总之，多巴酚丁胺负荷试验Tc-99m甲氧基异丁基异腈SPECT是接受冠状动脉造影以评估胸痛的患者未来心脏事件的有力预测指标，可用于对患者进行分层以进行进一步干预。
