Khattar R S, Senior R, Joseph D, Lahiri A
Northwick Park and St Mark's Hospitals National Health Service (NHS) Trust and the Institute of Medical Research, Harrow, Middlesex, United Kingdom.
J Nucl Cardiol. 1997 May-Jun;4(3):211-6. doi: 10.1016/s1071-3581(97)90081-7.
Arbutamine is a new synthetic catecholamine developed specifically for pharmacologic stress testing.
We investigated 39 patients undergoing coronary arteriography to compare arbutamine stress (99m)Tc-labeled sestamibi single-photon emission computed tomographic imaging and echocardiography for detection of the extent and severity of coronary artery disease and inducible ischemia. Rest and stress studies were analyzed blindly according to a 12-segment left ventricular model for both techniques. Each segment was graded according to severity of wall thickening abnormality and perfusion defect (1 = normal to 4 = severe). Total perfusion defect and wall thickening scores were calculated at peak stress and the difference in scores between stress and rest (delta perfusion defect; delta wall thickening) were used as indexes of inducible ischemia. Twenty-one patients had multivessel disease, nine had single-vessel disease, and nine had normal coronary arteries. Diagnostic accuracies for the detection of coronary artery disease for single-photon emission computed tomographic imaging and echocardiography were 95% and 92%, respectively. Extent and severity of coronary artery disease indicated by a peak stress perfusion defect score of 26 +/- 6.4 and wall thickening score of 25.1 +/- 8.4 were similar, and there was no significant difference in the delta perfusion defect and delta wall thickening scores of 8.7 +/- 5.5 and 10.4 +/- 7.1, respectively. Segmental concordance rates for the detection of coronary artery disease and inducible ischemia were 74% (K = 0.47; confidence interval 0.39 to 0.55) and 74% (kappa = 0.42; confidence interval 0.34 to 0.51), respectively. Regional concordance for coronary artery disease was 84% (kappa = 0.68; confidence interval 0.51 to 0.84). Where discordance was present, there was a greater prevalence of perfusion abnormality compared with wall thickening abnormality.
Arbutamine stress single-photon emission computed tomographic imaging and echocardiography provide largely equivalent and accurate pathophysiologic information for the evaluation of coronary artery disease and inducible ischemia.
阿巴胺是一种专门为药物负荷试验开发的新型合成儿茶酚胺。
我们对39例接受冠状动脉造影的患者进行了研究，以比较阿巴胺负荷（99m）锝标记的 sestamibi 单光子发射计算机断层显像和超声心动图检测冠状动脉疾病的范围和严重程度以及诱发心肌缺血的情况。两种技术均根据12节段左心室模型对静息和负荷研究进行盲法分析。根据室壁增厚异常和灌注缺损的严重程度对每个节段进行分级（1 = 正常至4 = 严重）。在负荷峰值时计算总灌注缺损和室壁增厚评分，并将负荷与静息时的评分差值（灌注缺损差值；室壁增厚差值）用作诱发心肌缺血的指标。21例患者患有多支血管病变，9例患有单支血管病变，9例冠状动脉正常。单光子发射计算机断层显像和超声心动图检测冠状动脉疾病的诊断准确性分别为95%和92%。负荷峰值时灌注缺损评分26±6.4和室壁增厚评分25.1±8.4所提示的冠状动脉疾病范围和严重程度相似，灌注缺损差值8.7±5.5和室壁增厚差值10.4±7.1也无显著差异。检测冠状动脉疾病和诱发心肌缺血的节段一致性率分别为74%（K = 0.47；置信区间0.39至0.55）和74%（kappa = 0.42；置信区间0.34至0.51）。冠状动脉疾病的区域一致性为84%（kappa = 0.68；置信区间0.51至0.84）。在存在不一致的情况下，与室壁增厚异常相比，灌注异常的发生率更高。
阿巴胺负荷单光子发射计算机断层显像和超声心动图在评估冠状动脉疾病和诱发心肌缺血方面提供了大致等效且准确的病理生理信息。
