多巴酚丁胺-阿托品负荷心肌灌注单光子发射计算机断层扫描成像在冠状动脉旁路移植术后移植血管狭窄诊断中的应用
Dobutamine-atropine stress myocardial perfusion SPECT imaging in the diagnosis of graft stenosis after coronary artery bypass grafting.
作者信息
Elhendy A, van Domburg R T, Bax J J, Nierop P R, Valkema R, Geleijnse M L, Kasprzak J D, Liqui-Lung A F, Cornel J H, Roelandt J R
机构信息
Thoraxcenter and the Department of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
出版信息
J Nucl Cardiol. 1998 Sep-Oct;5(5):491-7. doi: 10.1016/s1071-3581(98)90180-5.
OBJECTIVE
To assess the accuracy of dobutamine stress myocardial perfusion single photon emission computed tomographic imaging (SPECT) for the diagnosis of vascular stenosis after coronary artery bypass grafting (CABG).
BACKGROUND
Exercise thallium scintigraphy is a clinically useful method for the diagnosis of graft stenosis after CABG. Although dobutamine perfusion scintigraphy is an alternative method for the evaluation of patients with limited exercise capacity, its value in the diagnosis of vascular stenosis after CABG has not been studied.
METHODS
Dobutamine (up to 40 lg/kg/min)-atropine (up to 1 mg) stress test in conjunction with myocardial perfusion SPECT imaging (201T1 or 99m technetium sestamibi [MIBII) was performed in 71 patients (mean age 58 9 years, 57 men) with limited exercise capacity referred for evaluation of myocardial ischemia 3.7 3.5 years after CABG. Significant vascular stenosis was defined as >50% luminal diameter stenosis of a graft or a native nongrafted coronary artery and was predicted on the basis of reversible perfusion abnormalities.
RESULTS
Significant vascular stenosis was detected in 52 patients. Sensitivity, specificity, and accuracy of reversible perfusion defects at dobutamine SPECT for the overall diagnosis of vascular stenosis were 81%, confidence interval (CI) 72 to 90, 79%, CI 69 to 88, and 80%, CI 71 to 90, respectively. Significant vascular stenosis was detected in 73 arterial regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional vascular stenosis were 66%, CI 58 to 74, 83%, CI 76 to 89, and 74%, CI 67 to 81, respectively. Patients with multivessel stenosis had a higher number of ischemic segments (1.6 + 1.3 vs 1 + 1, P < .05) and ischemic perfusion score (3.2 2.7 vs 2.2 + 2.3, P < .05) than patients with single-vessel stenosis, respectively. Significant graft stenosis was detected in 67 graft regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional graft stenosis were 64%, CI 56 to 73, 85%, CI 78 to 91, and 74%, CI 66 to 82, respectively.
CONCLUSION
Dobutamine stress myocardial perfusion SPECT imaging is a useful method for the diagnosis of significant vascular stenosis after CABG in patients with limited exercise capacity.
目的
评估多巴酚丁胺负荷心肌灌注单光子发射计算机断层扫描成像（SPECT）对冠状动脉旁路移植术（CABG）后血管狭窄诊断的准确性。
背景
运动铊闪烁扫描术是诊断CABG术后移植血管狭窄的一种临床有用方法。尽管多巴酚丁胺灌注闪烁扫描术是评估运动能力受限患者的一种替代方法，但其在诊断CABG术后血管狭窄中的价值尚未得到研究。
方法
对71例（平均年龄58±9岁，57例男性）运动能力受限、因心肌缺血于CABG术后3.7±3.5年前来评估的患者进行多巴酚丁胺（最大剂量40μg/kg/min）-阿托品（最大剂量1mg）负荷试验并结合心肌灌注SPECT成像（201Tl或99m锝甲氧基异丁基异腈[MIBI]）。显著血管狭窄定义为移植血管或非移植的自身冠状动脉管腔直径狭窄>50%，并根据可逆性灌注异常进行预测。
结果
52例患者检测到显著血管狭窄。多巴酚丁胺SPECT检查中可逆性灌注缺损对血管狭窄总体诊断的敏感性、特异性和准确性分别为81%，可信区间（CI）72%至90%；79%，CI 69%至88%；80%，CI 71%至90%。在73个动脉区域检测到显著血管狭窄。多巴酚丁胺SPECT检查对局部血管狭窄诊断的敏感性、特异性和准确性分别为66%，CI 58%至74%；83%，CI 76%至89%；74%，CI 67%至81%。多支血管狭窄患者的缺血节段数（1.6±1.3比1±1，P<.05）和缺血灌注评分（3.2±2.7比2.2±2.3，P<.05）均高于单支血管狭窄患者。在67个移植血管区域检测到显著移植血管狭窄。多巴酚丁胺SPECT检查对局部移植血管狭窄诊断的敏感性、特异性和准确性分别为64%，CI 56%至73%；85%，CI 78%至91%；74%，CI 66%至82%。
结论
多巴酚丁胺负荷心肌灌注SPECT成像是诊断运动能力受限的CABG术后患者显著血管狭窄的一种有用方法。
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