运动负荷试验、药物负荷超声心动图和灌注断层扫描作为无冠心病病史胸痛患者一线检查的头对头比较
Head-to-head comparison of exercise stress testing, pharmacologic stress echocardiography, and perfusion tomography as first-line examination for chest pain in patients without history of coronary artery disease.
作者信息
Santoro G M, Sciagrà R, Buonamici P, Consoli N, Mazzoni V, Zerauschek F, Bisi G, Fazzini P F
机构信息
Division of Cardiology, Careggi Hospital, Florence, Italy.
出版信息
J Nucl Cardiol. 1998 Jan-Feb;5(1):19-27. doi: 10.1016/s1071-3581(98)80006-8.
BACKGROUND
To overcome the relatively low accuracy of exercise stress testing (EST) in detecting coronary artery disease (CAD), both echocardiography and perfusion scintigraphy have been evaluated in conjunction with pharmacologic stress, but there is still uncertainty of the relative value of these tests as possible first-line examinations for suspected CAD. This study evaluated the accuracy of EST, dipyridamole and dobutamine stress echocardiography (DIP-ECHO, DOB-ECHO), and dipyridamole and dobutamine technetium 99m sestamibi tomography (DIP-MIBI, DOB-MIBI) for the detection of CAD in patients evaluated for the first time because of chest pain.
METHODS AND RESULTS
Sixty patients underwent EST, DIP-ECHO, DOB-ECHO, DIP-MIBI, and DOB-MIBI. Echocardiographic images were acquired simultaneously with sestamibi injections, and the scintigraphic images were collected 1 hour later. Coronary angiography was performed within 15 days. Out of 33 patients with significant (>70%) coronary stenoses, 19 (58%) were correctly identified by EST, 18 (55%) by DIP-ECHO, 20 (61%) by DOB-ECHO, 32 (97%) by DIP-MIBI, and 30 (91%) by DOB-MIBI (p < 0.005 for MIBI vs EST and ECHO). The specificity of EST was 67% (p < 0.05 vs ECHO and MIBI), 96%, 96%, 89%, and 81%, respectively. Of the 62 stenotic coronary arteries, 20 (32%) were correctly identified by DIP-ECHO, 24 (39%) by DOB-ECHO, 48 (77%) by DIP-MIBI, and 45 (73%) by DOB-MIBI. The sensitivity of the imaging techniques in predicting the presence of multivessel disease was 14% and 29% for DIP and DOB-ECHO compared with 48% and 57% for DIP and DOB-MIBI.
CONCLUSIONS
Our results confirm the limited reliability of EST in detecting CAD and the good diagnostic value of DIP and DOB-MIBI. Conversely, the lower sensitivity and the poorer capability to recognize multivessel CAD do not support the role of either DIP or DOB-ECHO as first-line examination for suspected CAD.
背景
为克服运动负荷试验（EST）在检测冠状动脉疾病（CAD）方面相对较低的准确性，超声心动图和灌注闪烁扫描已与药物负荷相结合进行评估，但对于这些检查作为疑似CAD的一线检查的相对价值仍存在不确定性。本研究评估了EST、双嘧达莫和多巴酚丁胺负荷超声心动图（DIP-ECHO、DOB-ECHO）以及双嘧达莫和多巴酚丁胺锝99m甲氧基异丁基异腈断层扫描（DIP-MIBI、DOB-MIBI）在因胸痛首次接受评估的患者中检测CAD的准确性。
方法与结果
60例患者接受了EST、DIP-ECHO、DOB-ECHO、DIP-MIBI和DOB-MIBI检查。在注射甲氧基异丁基异腈的同时采集超声心动图图像，1小时后采集闪烁扫描图像。在15天内进行冠状动脉造影。在33例冠状动脉狭窄程度>70%的患者中，EST正确识别出19例（58%），DIP-ECHO正确识别出18例（55%），DOB-ECHO正确识别出20例（61%），DIP-MIBI正确识别出32例（97%），DOB-MIBI正确识别出30例（91%）（MIBI与EST和ECHO相比，p<0.005）。EST的特异性分别为67%（与ECHO和MIBI相比，p<0.05）、96%、96%、89%和81%。在62条狭窄的冠状动脉中，DIP-ECHO正确识别出20条（32%），DOB-ECHO正确识别出24条（39%），DIP-MIBI正确识别出48条（77%），DOB-MIBI正确识别出45条（73%）。DIP和DOB-ECHO在预测多支血管疾病存在方面的成像技术敏感性分别为14%和29%，而DIP和DOB-MIBI的敏感性分别为48%和57%。
结论
我们的结果证实了EST在检测CAD方面可靠性有限，以及DIP和DOB-MIBI具有良好的诊断价值。相反，较低的敏感性和识别多支血管CAD能力较差不支持将DIP或DOB-ECHO作为疑似CAD的一线检查。
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