双嘧达莫负荷铊-201单光子发射计算机断层心肌灌注成像对服用抗心绞痛药物患者冠状动脉疾病范围和严重程度的低估

Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 single-photon emission computed tomographic myocardial perfusion imaging in patients taking antianginal drugs.

作者信息

Sharir T, Rabinowitz B, Livschitz S, Moalem I, Baron J, Kaplinsky E, Chouraqui P

机构信息

Nuclear Cardiology Unit, Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.

出版信息

J Am Coll Cardiol. 1998 Jun;31(7):1540-6. doi: 10.1016/s0735-1097(98)00142-9.

DOI:10.1016/s0735-1097(98)00142-9

PMID:9626832

Abstract

OBJECTIVES

This study evaluated the diagnostic value of dipyridamole plus low level treadmill exercise (dipyridamole stress) thallium-201 single-photon emission computed tomography (SPECT) in patients taking antianginal drugs.

BACKGROUND

Dipyridamole stress is the major substitute for maximal exercise in patients referred for myocardial perfusion imaging. Although antianginal drugs are commonly suspended before exercise, dipyridamole stress is usually performed without discontinuing these drugs.

METHODS

Twenty-six patients underwent two dipyridamole perfusion studies: the first without (SPECT-1) and the second with (SPECT-2) antianginal treatment. Twenty-one patients (81%) received calcium antagonists, 19 (73%) received nitrates, and 8 (31%) received beta-blockers. Eighteen of the patients underwent coronary angiography. Data are presented as the mean value +/- SD.

RESULTS

Visual scoring yielded significantly larger and more severe reversible perfusion defects for SPECT-1 than for SPECT-2. Quantitative analysis showed larger perfusion defects on stress images of SPECT-1 in the left anterior descending coronary artery (LAD) (25 +/- 21% vs. 17 +/- 15%, p = 0.003), left circumflex coronary artery (LCx) (56 +/- 35% vs. 48 +/- 36%, p = 0.03) and right coronary artery (RCA) (36 +/- 27% vs. 25 +/- 24%, p = 0.008) territories. Individual vessel sensitivities in the LAD, LCx and RCA territories were 93%, 79% and 100% for SPECT-1 and 64%, 50% and 70% for SPECT-2, respectively. These differences were highly significant for the LAD (p = 0.004) and LCx (p = 0.00004) territories. The overall individual vessel sensitivity of SPECT-1 was significantly higher than that of SPECT-2 (92% vs. 62%, p = 0.000003). Specificity was not significantly different in SPECT-1 compared with SPECT-2 (80% and 93%, p = 0.33).

CONCLUSIONS

Continued use of antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.

摘要

目的

本研究评估了双嘧达莫联合低水平平板运动（双嘧达莫负荷试验）铊 - 201单光子发射计算机断层扫描（SPECT）在服用抗心绞痛药物患者中的诊断价值。

背景

双嘧达莫负荷试验是接受心肌灌注成像患者进行最大运动试验的主要替代方法。虽然在运动前通常会停用抗心绞痛药物，但双嘧达莫负荷试验通常在不停用这些药物的情况下进行。

方法

26例患者接受了两次双嘧达莫灌注研究：第一次在未进行（SPECT - 1）抗心绞痛治疗的情况下进行，第二次在进行（SPECT - 2）抗心绞痛治疗的情况下进行。21例患者（81%）接受钙拮抗剂治疗，19例（73%）接受硝酸盐类药物治疗，8例（31%）接受β受体阻滞剂治疗。18例患者接受了冠状动脉造影。数据以平均值±标准差表示。

结果

视觉评分显示，SPECT - 1的可逆性灌注缺损明显比SPECT - 2更大、更严重。定量分析显示，SPECT - 1在左前降支冠状动脉（LAD）（25±21%对17±15%，p = 0.003）、左旋支冠状动脉（LCx）（56±35%对48±36%，p = 0.03）和右冠状动脉（RCA）（36±27%对25±24%，p = 0.008）区域的负荷图像上有更大的灌注缺损。LAD、LCx和RCA区域的单个血管敏感性，SPECT - 1分别为93%、79%和100%，SPECT - 2分别为64%、50%和70%。这些差异在LAD（p = 0.004）和LCx（p = 0.00004）区域非常显著。SPECT - 1的总体单个血管敏感性显著高于SPECT - 2（92%对62%，p = 0.000003）。SPECT - 1与SPECT - 2相比，特异性没有显著差异（80%和93%，p = 0.33）。