Elsässer A, Müller K D, Vogt A, Strasser R, Gagel C, Schlepper M, Klövekorn W P
Kerckhoff-Clinic of the Max Planck Society, Bad Nauheim, Germany.
Am Heart J. 1998 Mar;135(3):463-75. doi: 10.1016/s0002-8703(98)70323-0.
The aim of this study was to evaluate the usefulness of dobutamine echocardiography and quantitative thallium-201 single photon emission computed tomography myocardial scintigraphy with reinjection in the detection of viable myocardium in patients with coronary artery disease and reduced left ventricular function, which will improve after aortocoronary bypass surgery. Forty-eight patients (47 men, aged 61 +/- 6 years) with angiographically documented reduced left ventricular function (ejection fraction 35 +/- 14, 63% with chronic transmural myocardial infarction) were examined by dobutamine two-dimensional echocardiography (before and during low dosage), 201Tl, and gated radionuclide ventriculography before and 3 +/- 2 months after aortocoronary bypass surgery. Four of 55 areas classified viable before operation were revascularized inadequately and discarded. Global left ventricular ejection fraction at rest rose from 35% +/- 14% before operation to 40% +/- 13% (p < 0.05) after operation. Stress-induced perfusion defects involved 40% +/- 19% of the left ventricle circumference after stress and showed a significant reduction of size to 23% +/- 14% (p < 0.01) at rest, 4 hours later, and after reinjection. This value fell to 16% +/- 12% (p < 0.05) 3 months after aortocoronary bypass surgery. We conclude that both dobutamine echocardiography (sensitivity 95%, specificity 80%, positive predictive value 87%, negative predictive value 88%) and 201Tl studies (sensitivity 87%, specificity 98%, positive predictive value 97%, negative predictive value 93%) are suitable and comparable accurate methods for predicting improvement in systolic function 3 months after revascularization in a selected population with a high prevalence of viable but hypokinetic or akinetic myocardium.
本研究的目的是评估多巴酚丁胺超声心动图以及定量铊-201单光子发射计算机断层扫描心肌闪烁显像再注射法在检测冠状动脉疾病伴左心室功能降低患者存活心肌方面的有效性，这类患者在主动脉冠状动脉搭桥手术后左心室功能将会改善。48例患者（47例男性，年龄61±6岁），血管造影显示左心室功能降低（射血分数35±14，63%伴有慢性透壁心肌梗死），在主动脉冠状动脉搭桥手术前及术后3±2个月接受了多巴酚丁胺二维超声心动图检查（低剂量用药前及用药期间）、铊-201检查以及门控放射性核素心室造影。术前判定为存活的55个区域中有4个区域血运重建不充分而被排除。静息时整体左心室射血分数从术前的35%±14%升至术后的40%±13%（p<0.05）。应激诱导的灌注缺损在应激后累及左心室周长的40%±19%，静息时、4小时后及再注射后缺损大小显著减小至23%±14%（p<0.01）。该值在主动脉冠状动脉搭桥手术后3个月降至16%±12%（p<0.05）。我们得出结论，多巴酚丁胺超声心动图（敏感性95%，特异性80%，阳性预测值87%，阴性预测值88%）和铊-201检查（敏感性87%，特异性98%，阳性预测值97%，阴性预测值93%）都是适用于预测特定人群（存活但运动减弱或无运动的心肌患病率高）血运重建后3个月收缩功能改善情况的、准确性相当的方法。
