Khattar R S, Senior R, Lahiri A
Department of Cardiovascular Medicine, Northwick Park Hospital, NHS Trust, Harrow, Middlesex, UK.
Heart. 1998 Mar;79(3):274-80. doi: 10.1136/hrt.79.3.274.
To assess whether inotropic stress myocardial perfusion imaging, echocardiography, or a combination of the two could enhance the detection of multivessel disease, over and above clinical and exercise electrocardiographic data.
100 consecutive patients investigated by exercise electrocardiography and diagnostic coronary arteriography underwent simultaneous inotropic stress Tc-99m sestamibi SPECT (MIBI) imaging and echocardiography. MIBI imaging and echocardiographic data were analysed using a 12 segment left ventricular model, and each segment was ascribed to a particular coronary artery territory. The presence of perfusion defects with MIBI imaging or of wall thickening abnormality with echocardiography in at least two coronary artery territories at peak stress was taken as diagnostic of multivessel disease. Arteriographic evidence of > or = 50% stenosis was considered significant.
56 patients had multivessel disease. The sensitivity of the combination of MIBI imaging and echocardiography for detecting this was greater than either MIBI imaging or echocardiography alone (82%, 68%, and 68%, respectively; p = 0.005). Clinical and exercise electrocardiographic variables gave an R2 value of 18.2% for predicting multivessel disease. The addition of either MIBI imaging (R2 = 29.2%; p = 0.002) or echocardiography (R2 = 28.8%; p < 0.001) enhanced the detection of multivessel disease, and the inclusion of both had further incremental value (R2 = 34.8%; p = 0.003). Age (p = 0.03), MIBI imaging (p = 0.007), and echocardiography (p = 0.001) were independent predictors of multivessel disease.
The assessment of both myocardial perfusion and contractile function by simultaneous inotropic stress MIBI imaging and echocardiography optimises the non-invasive detection of multivessel disease.
评估在临床和运动心电图数据之外，强心应激心肌灌注成像、超声心动图或两者联合使用是否能提高对多支血管病变的检测能力。
100例连续接受运动心电图检查和诊断性冠状动脉造影的患者同时接受了强心应激锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描（MIBI）成像和超声心动图检查。使用12节段左心室模型分析MIBI成像和超声心动图数据，每个节段对应特定的冠状动脉区域。将应激峰值时至少两个冠状动脉区域出现MIBI成像灌注缺损或超声心动图室壁增厚异常视为多支血管病变的诊断依据。动脉造影显示狭窄≥50%被认为具有显著性。
56例患者患有多支血管病变。MIBI成像和超声心动图联合检测的敏感性高于单独使用MIBI成像或超声心动图（分别为82%、68%和68%；p = 0.005）。临床和运动心电图变量预测多支血管病变的R2值为18.2%。单独添加MIBI成像（R2 = 29.2%；p = 0.002）或超声心动图（R2 = 28.8%；p < 0.001）均可提高对多支血管病变的检测能力，两者同时使用具有进一步的增量价值（R2 = 34.8%；p = 0.003）。年龄（p = 0.03）、MIBI成像（p = 0.007）和超声心动图（p = 0.001）是多支血管病变的独立预测因素。
通过强心应激MIBI成像和超声心动图同时评估心肌灌注和收缩功能可优化对多支血管病变的无创检测。
