Ha J W, Lee J D, Jang Y, Chung N, Kwan J, Rim S J, Lee Y J, Shim W H, Cho S Y, Kim S S
Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
J Nucl Cardiol. 1998 Nov-Dec;5(6):591-7. doi: 10.1016/s1071-3581(98)90113-1.
It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. However, no cardiac imaging modality has been able to demonstrate abnormal sympathetic innervation in patients with coronary artery spasm. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation using iodine 123-metaiodobenzylguanidine (123I-MIBG) single photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of 123I-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm.
Coronary arteriography and a provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (20 men, 6 women, mean age 48.2+/-12.0 years, range 20 to 67 years) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups: group 1 (n = 18) comprised subjects with a positive provocative test result, and group 2 (n = 8) comprised subjects with negative provocative test results. Ten healthy subjects served as controls. No abnormal MIBG uptake was observed in the control subjects. Abnormal sympathetic nervous innervation using 123I-MIBG SPECT was observed either as a reduced uptake or a defective pattern in the perfused areas in 13 of the 18 regions supplied by vessels of ergonovine-induced vasospasm. Normal sympathetic innervation, as evidenced by normal 123I-MIBG uptake, was noted in all of the 60 segments of normal vessel territories. Reduced uptake of 123I-MIBG was not detected in the perfused areas of 5 vasospasm-induced vessels (perfusion territory of left anterior descending coronary artery [LAD] and the right coronary artery [RCA] in 2 and 3 patients, respectively). The sensitivity and specificity of 123I-MIBG for detection of coronary artery spasm were 72.2% (95% confidence interval [CI] 55% to 89%) and 100%, respectively. The positive predictive and negative predictive values were 100% and 92.3% (95% CI 91% to 93%), respectively.
123I-MIBG SPECT is a feasible method to evaluate noninvasively and localize the territories of coronary arteries with spasm. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan results, but showing abnormalities in 123I-MIBG SPECT.
有人提出交感神经系统可能在冠状动脉痉挛的发生发展中起重要作用。然而，尚无心脏成像方式能够在冠状动脉痉挛患者中显示出异常的交感神经支配。本研究的目的是使用碘123 - 间碘苄胍（123I - MIBG）单光子发射计算机断层扫描（SPECT）评估异常交感神经支配的存在和位置，并评估123I - MIBG SPECT作为冠状动脉痉挛患者无创筛查试验的临床疗效。
对26例疑似冠状动脉痉挛的患者（20例男性，6例女性，平均年龄48.2±12.0岁，范围20至67岁）进行冠状动脉造影和静脉注射马来酸麦角新碱的激发试验。受试者分为2组：第1组（n = 18）包括激发试验结果阳性的受试者，第2组（n = 8）包括激发试验结果阴性的受试者。10名健康受试者作为对照。在对照受试者中未观察到异常的MIBG摄取。在由麦角新碱诱导的血管痉挛的血管供应的18个区域中的13个区域，使用123I - MIBG SPECT观察到异常的交感神经支配，表现为灌注区域摄取减少或模式缺陷。在正常血管区域的所有60个节段中均观察到123I - MIBG摄取正常，证明交感神经支配正常。在5条血管痉挛诱导血管的灌注区域未检测到123I - MIBG摄取减少（分别在2例和3例患者中为左前降支冠状动脉[LAD]和右冠状动脉[RCA]的灌注区域）。123I - MIBG检测冠状动脉痉挛的敏感性和特异性分别为72.2%（95%置信区间[CI] 55%至89%）和100%。阳性预测值和阴性预测值分别为100%和92.3%（95% CI 91%至93%）。
123I - MIBG SPECT是一种评估冠状动脉痉挛区域的无创且定位的可行方法。对于静息时典型疼痛、运动试验阴性或铊灌注扫描结果正常但123I - MIBG SPECT显示异常的患者，可能无需进行侵入性诊断性冠状动脉造影及麦角新碱激发试验来诊断冠状动脉痉挛。
