Elhendy A, Geleijnse M L, Roelandt J R, van Domburg R T, Ten Cate F J, Nierop P R, Bax J J, El-Refaee M, Ibrahim M M, El-Said G M, Fioretti P M
Department of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
Am J Cardiol. 1997 Jan 1;79(1):7-12. doi: 10.1016/s0002-9149(96)00667-4.
This study compares the value of dobutamine stress echocardiography and 99m-technetium methoxyisobutyl-isonitrile (MIBI) single-photon emission computed tomography (SPECT) in the assessment of extent and location of coronary narrowing in patients with healed myocardial infarction. Dobutamine (up to 40 microg/kg/ min)-atropine (up to 1 mg) stress echocardiography (DSE) in conjunction with MIBI SPECT was performed in 72 patients (52 men, mean age 57 +/- 11 years) with healed myocardial infarction referred for evaluation of myocardial ischemia. Ischemia was defined as new or worsened wall motion abnormalities at DSE and reversible perfusion defects at MIBI SPECT. Significant stenosis (> or = 50% luminal diameter stenosis) of the infarct-related artery was detected in 45 patients and of other coronary arteries in 22 patients. Sensitivity and specificity of remote ischemia for diagnosis of remote coronary stenosis were 68% (95% confidence interval [CI] 57 to 80) and 93% (CI 86 to 99) for DSE, and 64% (CI 52 to 76), and 90% (CI 83 to 98) for MIBI SPECT, respectively. The positive predictive value and specificity of peri-infarction ischemia for the diagnosis of infarct-related artery stenosis were 89% (CI 81 to 97) and 82% (CI 73 to 92) for DSE, and 87% (CI 79 to 95) and 82% (CI 73 to 92) for SPECT, respectively. The agreement between both techniques was higher for the diagnosis of remote than peri-infarction ischemia (84% vs 66%, p = 0.02). It is concluded that in patients with myocardial infarction undergoing dobutamine stress testing, both echocardiography and MIBI SPECT are clinically useful methods for the diagnosis of remote and infarct-related coronary artery stenosis.
本研究比较了多巴酚丁胺负荷超声心动图和99m-锝甲氧基异丁基异腈（MIBI）单光子发射计算机断层扫描（SPECT）在评估陈旧性心肌梗死患者冠状动脉狭窄程度和部位方面的价值。对72例（52例男性，平均年龄57±11岁）因心肌缺血评估而转诊的陈旧性心肌梗死患者进行了多巴酚丁胺（最大剂量40μg/kg/min）-阿托品（最大剂量1mg）负荷超声心动图（DSE）联合MIBI SPECT检查。缺血定义为DSE时新出现或加重的室壁运动异常以及MIBI SPECT时可逆性灌注缺损。45例患者检测到梗死相关动脉严重狭窄（管腔直径狭窄≥50%），22例患者检测到其他冠状动脉严重狭窄。DSE诊断远隔缺血的敏感性和特异性分别为68%（95%置信区间[CI]57至80）和93%（CI 86至99），MIBI SPECT的敏感性和特异性分别为64%（CI 52至76）和90%（CI 83至98）。DSE诊断梗死周边缺血的阳性预测值和特异性分别为89%（CI 81至97）和82%（CI 73至92），SPECT的阳性预测值和特异性分别为87%（CI 79至95）和82%（CI 73至92）。两种技术在诊断远隔缺血方面的一致性高于梗死周边缺血（84%对66%，p = 0.02）。结论是，在接受多巴酚丁胺负荷试验的心肌梗死患者中，超声心动图和MIBI SPECT都是诊断远隔和梗死相关冠状动脉狭窄的临床有用方法。
