Elhendy A, van Domburg R T, Bax J J, Nierop P R, Geleijnse M L, Ibrahim M M, Roelandt J R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.
Chest. 1998 Oct;114(4):1097-104. doi: 10.1378/chest.114.4.1097.
To compare the accuracy of dobutamine stress echocardiography (DSE) and simultaneous 99mTc sestamibi (MIBI) single-photon emission CT (SPECT) imaging for the diagnosis of coronary artery stenosis in women.
Seventy women with limited exercise capacity referred for evaluation of myocardial ischemia.
DSE (up to 40 microg/kg/min) was performed in conjunction with stress MIBI SPECT. Resting MIBI images were acquired 24 h after the stress test. Ischemia was defined as new or worsened wall motion abnormalities confirmed by DSE and as reversible perfusion defects confirmed by MIBI. Significant coronary artery disease was defined as > or = 50% luminal diameter stenosis.
DSE was positive for ischemia in 35 of 45 patients with coronary artery stenosis and in 2 of 25 patients without coronary artery stenosis (sensitivity = 78% CI, 68 to 88; specificity = 92% CI, 85 to 99; and accuracy = 83% CI, 74 to 92). A positive MIBI study for ischemia occurred in 29 patients with coronary artery stenosis and in 7 patients without coronary artery stenosis (sensitivity = 64% CI, 53 to 76; specificity = 72% CI, 61 to 83; and accuracy = 67% CI, 56 to 78 [p < 0.05 vs DSE]). In the 59 vascular regions with coronary artery stenosis, the regional sensitivity of DSE was higher than MIBI (69% CI, 62 to 77 vs 51% CI, 42 to 59, p < 0.05), whereas specificity in the 81 vascular regions without significant stenosis was similar (89% CI, 84 to 94 vs 88% CI, 82 to 93, respectively).
DSE is a useful noninvasive method for the diagnosis of coronary artery stenosis in women and provides a higher overall and regional diagnostic accuracy than dobutamine MIBI SPECT in this particular population.
比较多巴酚丁胺负荷超声心动图（DSE）与同步99m锝-甲氧基异丁基异腈（MIBI）单光子发射计算机断层扫描（SPECT）成像对女性冠状动脉狭窄的诊断准确性。
70名运动能力受限的女性因心肌缺血评估前来就诊。
进行DSE（最高达40微克/千克/分钟）并同步进行负荷MIBI SPECT检查。负荷试验后24小时采集静息MIBI图像。缺血定义为DSE证实的新的或加重的室壁运动异常以及MIBI证实的可逆性灌注缺损。显著冠状动脉疾病定义为管腔直径狭窄≥50%。
45例冠状动脉狭窄患者中有35例DSE缺血阳性，25例无冠状动脉狭窄患者中有2例阳性（敏感性=78%，可信区间68%至88%；特异性=92%，可信区间85%至99%；准确性=83%，可信区间74%至92%）。29例冠状动脉狭窄患者和7例无冠状动脉狭窄患者MIBI检查缺血阳性（敏感性=64%，可信区间53%至76%；特异性=72%，可信区间61%至83%；准确性=67%，可信区间56%至78%[与DSE相比，p<0.05]）。在59个存在冠状动脉狭窄的血管区域，DSE的区域敏感性高于MIBI（69%，可信区间62%至77%对51%，可信区间42%至59%，p<0.05），而在81个无显著狭窄的血管区域特异性相似（分别为89%，可信区间84%至94%对88%，可信区间82%至93%）。
DSE是诊断女性冠状动脉狭窄的一种有用的非侵入性方法，在这一特定人群中，其总体和区域诊断准确性高于多巴酚丁胺MIBI SPECT。
