Soman P, Khattar R, Senior R, Lahiri A
Northwick Park Hospital, Harrow, Middlesex, United Kingdom.
J Nucl Cardiol. 1997 Sep-Oct;4(5):364-71. doi: 10.1016/s1071-3581(97)90027-1.
There is a paucity of data comparing the relative merits of inotropic and vasodilator stress Tc-99m sestamibi single-photon emission computed tomography (SPECT) for the detection of coronary artery disease and reversible ischemia.
Twenty-seven patients referred for diagnostic coronary arteriography underwent separate day dipyridamole and arbutamine Tc-99m sestamibi SPECT imaging with simultaneous two-dimensional echocardiography. The sensitivity of arbutamine and dipyridamole Tc-99m sestamibi for the detection of coronary artery disease was 100% (21 of 21) and 90% (19 of 21), respectively, with a specificity of 66% (4 of 6) for both. Coronary artery disease was detected in all six patients with single vessel disease by both stress modalities. The sensitivity for prediction of multivessel disease was 66% (10 of 15) for arbutamine and 46% (7 of 15) for dipyridamole stress. Arbutamine stress induced a greater extent and severity of perfusion abnormality at peak stress (peak perfusion score 25 +/- 6.2 and 21 +/- 5.9 for arbutamine and dipyridamole, respectively, p = 0.001) and reversible perfusion defects (difference between peak stress and rest scores 8.8 +/- 5.5 and 5.2 +/- 4.4 for arbutamine and dipyridamole, respectively, p = 0.001). Furthermore a significantly higher percentage of reversible defects induced by arbutamine stress was associated with wall thickening abnormality on simultaneous echocardiography, which is a more specific marker of myocardial ischemia (88% and 24% for arbutamine and dipyridamole, respectively, p = 0.002).
Inotropic stress may be superior to vasodilators for the determination of the extent and severity of myocardial involvement and reversible ischemia by Tc-99m sestamibi SPECT.
关于用于检测冠状动脉疾病和可逆性心肌缺血的正性肌力药物负荷与血管扩张剂负荷锝-99m 甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）的相对优缺点，相关数据较少。
27 例因诊断性冠状动脉造影而就诊的患者，在不同日期分别接受了双嘧达莫和阿巴明负荷锝-99m 甲氧基异丁基异腈 SPECT 成像，并同时进行二维超声心动图检查。阿巴明和双嘧达莫负荷锝-99m 甲氧基异丁基异腈检测冠状动脉疾病的敏感性分别为 100%（21 例中的 21 例）和 90%（21 例中的 19 例），两者的特异性均为 66%（6 例中的 4 例）。两种负荷方式均在所有 6 例单支血管病变患者中检测到冠状动脉疾病。阿巴明负荷预测多支血管病变的敏感性为 66%（15 例中的 10 例），双嘧达莫负荷为 46%（15 例中的 7 例）。阿巴明负荷在峰值负荷时引起的灌注异常程度和严重程度更大（阿巴明和双嘧达莫的峰值灌注评分分别为 25±6.2 和 21±5.9，p = 0.001），可逆性灌注缺损也更大（阿巴明和双嘧达莫的峰值负荷与静息评分之差分别为 8.8±5.5 和 5.2±4.4，p = 0.001）。此外，阿巴明负荷诱导的可逆性缺损中，与同时进行的超声心动图上室壁增厚异常相关的比例显著更高，而室壁增厚异常是心肌缺血更具特异性的标志物（阿巴明和双嘧达莫分别为 88%和 24%，p = 0.002）。
对于通过锝-99m 甲氧基异丁基异腈 SPECT 确定心肌受累程度和可逆性心肌缺血，正性肌力药物负荷可能优于血管扩张剂负荷。
