Harada M, Okura K, Nishizawa S, Inoue T, Sakai H, Lee T, Sugiyama Y, Suzuki M, Hirai H, Yamaguchi T
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo.
J Cardiol. 1998 Sep;32(3):163-71.
The clinical feasibility and usefulness of adenosine triphosphate-2Na (ATP) stress echocardiography for the detection of coronary artery disease (CAD) were assessed. Two-dimensional echocardiography and thallium-201 single photon emission computed tomography (SPECT) during ATP infusion were performed simultaneously in 58 consecutive patients (41 men and 17 women; mean age 66 +/- 12 years) with suspected CAD. ATP was infused intravenously at 0.16 mg/kg/min for 5 min and thallium was injected at 4 min. All patients underwent coronary angiography within 2 weeks of ATP echocardiography and ATP SPECT. An ischemic response during ATP infusion was detected by echocardiography as the development or worsening of a wall motion abnormality compared with the baseline and by SPECT as a perfusion defect that filled totally or partially during redistribution. Significant coronary artery stenosis was defined as > or = 75% diameter stenosis in a major epicardial vessel. The severity of the stenosis was classified as follows: Group A, lesions with significant coronary artery stenosis (> or = 75%, < 90%); Group B, lesions with severe coronary artery stenosis (> or = 90%) without collateral circulation; Group C, lesions with severe coronary artery stenosis (> or = 90%) with collateral circulation. Significant CAD was present in 43 of 58 patients. The overall sensitivity, specificity and accuracy of ATP echocardiography for detecting significant CAD were 70%, 100% and 78%, respectively, and those of ATP SPECT were 98%, 87% and 95%, respectively. In patients without previous myocardial infarction, the sensitivity of ATP echocardiography was 67%. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia were 59% and 95% in patients with 1-vessel disease, 75% and 100% in those with 2-vessel disease, and 88% and 100% in those with 3-vessel disease, respectively. The induction of wall motion abnormality by ATP echocardiography was highly concordant with ATP SPECT imaging in patients with multivessel disease. Although the sensitivity of ATP echocardiography improved in patients with multivessel disease more than in those with single-vessel disease, detection of all diseased vessels was achieved in only 10% of patients with multivessel disease. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in individual vessels were: right coronary artery, 58% and 74%; left anterior descending artery, 59% and 97%; left circumflex artery, 27% and 68%. ATP-induced transient perfusion defects were associated with transient wall motion abnormality in only 57% of segments. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in patients with severe coronary stenosis were: Group A, 32% and 66%; Group B, 60% and 93%; Group C, 80% and 95%. The sensitivity of ATP echocardiography was significantly higher in the lesions with collateral circulation than in those without collateral circulation. ATP stress echocardiography is useful for detecting myocardial ischemia in patients with multivessel disease and in patients with severe coronary artery stenosis (> or = 90%). In particular, transient wall motion abnormality tends to be detected in the segments perfused by collateral circulation.
评估了三磷酸腺苷二钠（ATP）负荷超声心动图检测冠状动脉疾病（CAD）的临床可行性和实用性。对58例疑诊CAD的连续患者（41例男性和17例女性；平均年龄66±12岁）同时进行二维超声心动图检查和ATP输注期间的铊-201单光子发射计算机断层扫描（SPECT）。以0.16mg/kg/min的速度静脉输注ATP 5分钟，并在4分钟时注射铊。所有患者在ATP超声心动图和ATP SPECT检查后2周内接受冠状动脉造影。ATP输注期间的缺血反应通过超声心动图检测为与基线相比室壁运动异常的出现或加重，通过SPECT检测为再分布期间完全或部分填充的灌注缺损。显著冠状动脉狭窄定义为主要心外膜血管直径狭窄≥75%。狭窄程度分类如下：A组，冠状动脉显著狭窄（≥75%，<90%）的病变；B组，无侧支循环的严重冠状动脉狭窄（≥90%）的病变；C组，有侧支循环的严重冠状动脉狭窄（≥90%）的病变。58例患者中有43例存在显著CAD。ATP超声心动图检测显著CAD的总体敏感性、特异性和准确性分别为70%、100%和78%，ATP SPECT的分别为98%、87%和95%。在无既往心肌梗死的患者中，ATP超声心动图的敏感性为67%。单支血管病变患者中ATP超声心动图和ATP SPECT检测心肌缺血的敏感性分别为59%和95%，双支血管病变患者中分别为75%和100%，三支血管病变患者中分别为88%和100%。在多支血管病变患者中，ATP超声心动图诱导的室壁运动异常与ATP SPECT成像高度一致。尽管多支血管病变患者中ATP超声心动图的敏感性比单支血管病变患者提高得更多，但仅10%的多支血管病变患者能检测到所有病变血管。ATP超声心动图和ATP SPECT检测各支血管心肌缺血的敏感性分别为：右冠状动脉，58%和74%；左前降支动脉，59%和97%；左旋支动脉，27%和68%。ATP诱导的短暂灌注缺损仅在57%的节段中与短暂室壁运动异常相关。严重冠状动脉狭窄患者中ATP超声心动图和ATP SPECT检测心肌缺血的敏感性分别为：A组，32%和66%；B组，60%和93%；C组，80%和95%。有侧支循环的病变中ATP超声心动图的敏感性显著高于无侧支循环的病变。ATP负荷超声心动图对检测多支血管病变患者和严重冠状动脉狭窄（≥90%）患者的心肌缺血有用。特别是，在由侧支循环灌注的节段中倾向于检测到短暂室壁运动异常。
