Caner B, Karanfil A, Uysal U, Tokgozoglu L, Aksoyek S, Ugur O, Ciftci I, Atalar E, Kes S, Bekdik C
Department of Nuclear Medicine, Hacettepe University Medical Faculty, Ankara, Turkey.
Nucl Med Commun. 1997 Jun;18(6):567-73. doi: 10.1097/00006231-199706000-00012.
The aim of this study was to examine the value of an additional atropine injection in patients who do not achieve an adequate heart rate during dobutamine infusion for myocardial perfusion SPET (single photon emission tomography). Patients undergoing dobutamine myocardial SPET who failed to achieve > or = 85% of their age-predicted maximal heart rate at the end of dobutamine infusion (D protocol) had a second dobutamine myocardial SPET study on a separate day with the addition of an atropine injection during the dobutamine infusion (D + A protocol). Twenty-nine patients were studied. 201Tl was used in 27 patients and 99Tc(m)-MIBI in two patients. All patients underwent coronary angiography and significant coronary artery disease was found in 19 of 29 patients. The mean heart rate obtained at the peak of dobutamine infusion in the D + A protocol was significantly higher than that in the D protocol (153.8 +/- 13.8 vs 117.5 +/- 15.3 beats min[-1]). The D + A protocol resulted in a higher diagnostic sensitivity for the detection of stenosed coronaries compared with the D protocol (87 vs 80%, P > 0.05) without changing the specificity (89% for both protocols). On the other hand, the frequency of side-effects and ECG changes during the D + A protocol was higher than that with the D protocol (32 vs 47). In conclusion, the addition of an atropine injection during dobutamine infusion resulted in a higher diagnostic sensitivity for identifying stenosed coronaries compared to dobutamine alone.
本研究的目的是探讨在多巴酚丁胺输注用于心肌灌注单光子发射计算机断层扫描（SPET）时心率未达适当水平的患者中额外注射阿托品的价值。接受多巴酚丁胺心肌SPET检查的患者，若在多巴酚丁胺输注结束时（D方案）未达到其年龄预测最大心率的≥85%，则在另一天进行第二次多巴酚丁胺心肌SPET检查，在多巴酚丁胺输注期间加用阿托品注射（D + A方案）。对29例患者进行了研究。27例患者使用了201Tl，2例患者使用了99Tc（m）-甲氧基异丁基异腈。所有患者均接受了冠状动脉造影，29例患者中有19例发现有显著冠状动脉疾病。D + A方案中多巴酚丁胺输注峰值时获得的平均心率显著高于D方案（153.8±13.8对117.5±15.3次/分钟）。与D方案相比，D + A方案对检测冠状动脉狭窄的诊断敏感性更高（87%对80%，P>0.05），而特异性未改变（两种方案均为89%）。另一方面，D + A方案期间的副作用和心电图改变频率高于D方案（32对47）。总之，与单独使用多巴酚丁胺相比，多巴酚丁胺输注期间加用阿托品注射对识别冠状动脉狭窄具有更高的诊断敏感性。
