多巴酚丁胺负荷99锝-甲氧基异丁基异腈单光子发射计算机断层扫描心肌灌注显像在无法进行运动负荷试验的经皮腔内冠状动脉成形术患者再狭窄预测中的应用

Dobutamine 99Tcm-MIBI SPET myocardial perfusion scintigraphy in the prediction of restenosis after percutaneous transluminal coronary angioplasty in patients unable to perform an exercise stress test.

作者信息

Elhendy A, Geleijnse M L, Roelandt J R, van Domburg R T, Nierop P R, Bax J J, Kasprzak J D, el-Said G M, Ibrahim M M, Fioretti P M

机构信息

Thorax Centre, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.

出版信息

Nucl Med Commun. 1997 Feb;18(2):122-8. doi: 10.1097/00006231-199702000-00006.

DOI:10.1097/00006231-199702000-00006

PMID:9076767

Abstract

After successful percutaneous transluminal coronary angioplasty (PTCA), restenosis occurs in a relatively high proportion of patients. Exercise thallium scintigraphy is a useful method for the detection of restenosis. In patients unable to exercise, dobutamine perfusion scintigraphy may represent a feasible alternative. However, its diagnostic accuracy in this clinical setting has not been evaluated. We studied 40 patients (29 males, 11 females) aged 57 +/- 9 years, at a mean of 185 +/- 80 days after successful PTCA with a high-dose dobutamine (up to 40 micrograms kg-1 min-1) stress test, in conjunction with 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) single photon emission tomography (SPET). Significant restenosis was defined as > or = 50% luminal diameter stenosis of a coronary segment with previous PTCA and was predicted on the basis of the occurrence of reversible perfusion defects in the corresponding territories. Reversible perfusion defects occurred in 20 of 29 arteries with and in 4 of 17 arteries without restenosis. The sensitivity of dobutamine MIBI for the detection of restenosis in arteries with previous PTCA was 69% (CI = 56-82), the specificity 76% (CI = 64-89), the positive predictive value 83% (CI = 73-94), the negative predictive value 59% (CI = 45-73) and accuracy 72% (CI = 59-85). The overall sensitivity of 99Tcm-MIBI SPET for the diagnosis of significant coronary stenosis (including arteries without previous PTCA) on a patient basis was 79% (CI = 67-92), the specificity 82% (CI = 70-94) and accuracy 80% (CI = 68-92). The sensitivity of 99Tcm-MIBI SPET was significantly higher than that of electrocardiography (79 vs 38%, P < 0.005). It is concluded that dobutamine 99Tcm-MIBI SPET is a useful method for the detection of restenosis after PTCA in patients unable to perform an exercise stress test.

摘要

经皮腔内冠状动脉成形术（PTCA）成功后，相当一部分患者会发生再狭窄。运动铊闪烁扫描术是检测再狭窄的一种有用方法。对于无法进行运动的患者，多巴酚丁胺灌注闪烁扫描术可能是一种可行的替代方法。然而，其在这种临床情况下的诊断准确性尚未得到评估。我们研究了40例患者（29例男性，11例女性），年龄57±9岁，在成功进行PTCA后平均185±80天，进行高剂量多巴酚丁胺（高达40微克·千克⁻¹·分钟⁻¹）负荷试验，并结合⁹⁹ᵀcₘ-甲氧基异丁基异腈（⁹⁹ᵀcₘ-MIBI）单光子发射断层扫描（SPET）。显著再狭窄定义为先前PTCA的冠状动脉节段管腔直径狭窄≥50%，并根据相应区域可逆性灌注缺损的发生情况进行预测。在有再狭窄的29条动脉中有20条出现可逆性灌注缺损，在无再狭窄的17条动脉中有4条出现可逆性灌注缺损。多巴酚丁胺MIBI检测先前PTCA动脉再狭窄的敏感性为69%（可信区间=56-82），特异性为76%（可信区间=64-89），阳性预测值为83%（可信区间=73-94），阴性预测值为59%（可信区间=45-73），准确性为72%（可信区间=59-85）。基于患者的⁹⁹ᵀcₘ-MIBI SPET诊断显著冠状动脉狭窄（包括先前未进行PTCA的动脉）的总体敏感性为79%（可信区间=67-92），特异性为82%（可信区间=70-94），准确性为80%（可信区间=68-92）。⁹⁹ᵀcₘ-MIBI SPET的敏感性显著高于心电图（79%对38%，P<0.005）。结论是，多巴酚丁胺⁹⁹ᵀcₘ-MIBI SPET是检测无法进行运动负荷试验的PTCA术后患者再狭窄的一种有用方法。