血运重建术后心室功能改善的预测。18F-氟脱氧葡萄糖单光子发射计算机断层扫描与低剂量多巴酚丁胺超声心动图对比

Prediction of improvement of ventricular function after revascularization. 18F-fluorodeoxyglucose single-photon emission computed tomography vs low-dose dobutamine echocardiography.

作者信息

Cornel J H, Bax J J, Fioretti P M, Visser F C, Maat A P, Boersma E, van Lingen A, Elhendy A, Roelandt J R

机构信息

Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.

出版信息

Eur Heart J. 1997 Jun;18(6):941-8. doi: 10.1093/oxfordjournals.eurheartj.a015382.

DOI:10.1093/oxfordjournals.eurheartj.a015382

PMID:9183585

Abstract

AIMS

To compare assessment of myocardial flow and glucose metabolism by single-photon emission computed tomography (SPECT) with low-dose dobutamine echocardiography in predicting improvement in regional and global left ventricular function after coronary artery bypass grafting.

METHODS AND RESULTS

Thirty patients with regional wall motion abnormalities (mean ejection fraction 32 +/- 19%) were studied with low-dose dobutamine echocardiography (5 and 10 micrograms. kg-1 min-1) and thallium-201/ 18F-fluorodeoxyglucose(FDG) SPECT prior to surgery. For comparative analysis, a 13-segment model was used. Postoperative improvement was predicted if the echocardiogram showed that wall motion abnormalities were reversible during the dobutamine infusion and there was normal perfusion or relatively increased FDG uptake in perfusion defects (mismatch) in dyssynergic segments on SPECT. After surgery, ventricular function was reassessed. An echocardiogram was taken at the 3 month follow-up with the patient at rest. Regional wall motion had improved in 62/168 (37%) revascularized segments. In predicting functional outcome, low-dose dobutamine echocardiography reached a sensitivity of 89% and a specificity of 82%, with a positive predictive value of 74% and a negative predictive value of 93%, whereas for thallium-201/FDG SPECT these values were 84%, 86%, 78% and 90%, respectively. In patients with more than two viable segments on either technique, the wall motion score index, a surrogate of global ventricular function, improved significantly.

CONCLUSION

For the optimal prediction of functional outcome, combined assessment of flow and FDG imaging is needed. Both thallium-201/FDG SPECT and low-dose dobutamine echocardiography appear comparable and similarly accurate in predicting improvement of left ventricular function after surgical revascularization.

摘要

目的

比较单光子发射计算机断层扫描（SPECT）评估心肌血流和葡萄糖代谢与低剂量多巴酚丁胺超声心动图在预测冠状动脉旁路移植术后局部和整体左心室功能改善方面的效果。

方法与结果

对30例存在局部室壁运动异常（平均射血分数32±19%）的患者在手术前进行低剂量多巴酚丁胺超声心动图（5和10微克·千克⁻¹·分钟⁻¹）及铊-201/¹⁸F-氟脱氧葡萄糖（FDG）SPECT检查。为进行对比分析，采用13节段模型。若超声心动图显示在多巴酚丁胺输注期间室壁运动异常可逆，且SPECT上运动不协调节段的灌注缺损处有正常灌注或FDG摄取相对增加（不匹配），则预测术后功能改善。术后重新评估心室功能。在3个月随访时让患者静息状态下进行超声心动图检查。168个血运重建节段中有62个（37%）的局部室壁运动得到改善。在预测功能结局方面，低剂量多巴酚丁胺超声心动图的敏感性为89%，特异性为82%，阳性预测值为74%，阴性预测值为93%，而铊-201/FDG SPECT的这些值分别为84%、86%、78%和90%。在两种技术检测出有两个以上存活节段的患者中，作为整体心室功能替代指标的室壁运动评分指数有显著改善。