Elhendy A, Geleijnse M L, van Domburg R T, Bax J J, Nierop P R, Beerens S A, Valkema R, Krenning E P, Mohsen Ibrahim M, Roelandt J R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
Eur J Nucl Med. 1998 Jan;25(1):69-78. doi: 10.1007/s002590050196.
Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine (up to 40 microg kg-1min-1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant coronary artery disease (>/=50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%-82%), 83% (CI 75%-91%) and 75% (CI 66%-84%), those for MIBI were 67% (CI 57%-77%), 83% (CI 75%-91%) and 70% (CI 60%-80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%-69%), 90% (CI 86%-94%) and 77% (CI 72%-82%). Those for MIBI were 58% (CI 51%-64%), 91% (CI 87%-94%) and 75% (CI 69%-80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients, dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates for stress myocardial perfusion scintigraphy.
负荷超声心动图已被认为是诊断高血压患者及左心室肥厚患者冠状动脉疾病的一种准确方法。相比之下，心肌灌注闪烁显像在这些患者中的特异性受到了质疑。本研究的目的是比较这两种成像方式联合多巴酚丁胺负荷试验在诊断有或无左心室肥厚的高血压患者冠状动脉疾病方面的准确性。对84例因心肌缺血评估而转诊的系统性高血压患者进行了多巴酚丁胺（最大剂量40μg·kg-1·min-1）负荷超声心动图检查，并联合锝-99m甲氧基异丁基异腈（MIBI）单光子发射断层扫描（SPET）。缺血定义为超声心动图上新出现或加重的室壁运动异常以及SPET上的可逆性灌注缺损。66例患者（79%）检测到显著冠状动脉疾病（管腔直径狭窄≥50%）。超声心动图上缺血模式诊断冠状动脉疾病的敏感性、特异性和准确性分别为73%（95%可信区间63%-82%）、83%（95%可信区间75%-91%）和75%（95%可信区间66%-84%），MIBI的分别为67%（95%可信区间57%-77%）、83%（95%可信区间75%-91%）和70%（95%可信区间60%-80%）（与超声心动图相比P=无显著性差异）。在252条分析的冠状动脉中，123条（49%）检测到显著狭窄。超声心动图对冠状动脉疾病区域诊断的敏感性、特异性和准确性分别为63%（95%可信区间56%-69%）、90%（95%可信区间86%-94%）和77%（95%可信区间72%-82%）。MIBI 的分别为58%（95%可信区间5%-64%）、91%（95%可信区间87%-94%）和75%（95%可信区间69%-80%）（与超声心动图相比P=无显著性差异）。通过超声心动图检测到59例患者（70%）有左心室肥厚，且左心室肥厚不影响超声心动图或MIBI SPET的整体或区域特异性。结论是，在高血压患者中，多巴酚丁胺负荷超声心动图和MIBI SPET在冠状动脉疾病的整体和区域诊断方面具有相当的准确性。有或无左心室肥厚的高血压患者不应被视为不适合进行负荷心肌灌注闪烁显像的对象。
