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1.
Abdou Elhendy Arend F. L. Schinkel Ron T. van Domburg Jeroen J. Bax Roelf Valkema Don Poldermans 《Journal of nuclear cardiology》2003,10(6):615-622
BACKGROUND: The aim of this study was to assess the incremental prognostic value of stress technetium 99m tetrofosmin imaging after myocardial revascularization. METHODS AND RESULTS: We studied 381 patients (aged 60 +/- 10 years, 270 men), 4.5 +/- 3.2 years after myocardial revascularization (coronary artery bypass grafting in 201 patients and percutaneous coronary intervention in 180 patients), who underwent exercise or dobutamine stress tetrofosmin single photon emission computed tomography. Events during a mean follow-up period of 3.5 +/- 1.4 years were cardiac death in 22 patients, nonfatal myocardial infarction in 11 patients (33 hard cardiac events), and late revascularization in 50 patients. There was no incidence of hard cardiac events in the 100 patients with normal perfusion. Hard cardiac events occurred in 19% of patients with reversible perfusion abnormalities and in 4% of patients without them (P <.01). The incidence of hard cardiac events was similar in patients with and without angina before stress testing (17/197 [8.6%] vs 16/184 [8.7%]). In a multivariate analysis model, predictors of cardiac death were stress rate pressure product and abnormal perfusion. Reversible perfusion abnormalities were independently associated with the composite endpoints of cardiac death, nonfatal myocardial infarction, and late revascularization. In an incremental multivariate analysis model, an abnormal scan was additive to clinical data in the prediction of hard cardiac events (model chi(2) = 17 vs 11, P <.01). CONCLUSION: Stress Tc-99m tetrofosmin myocardial perfusion imaging provides independent prognostic information for the prediction of cardiac events after myocardial revascularization. Symptoms are not predictive of outcome, and therefore asymptomatic patients should not be deferred from stress testing. A normal study identifies a very low-risk population in whom no further intervention is required. 相似文献
2.
Abdou Elhendy Arend F. L. Schinkel Ron T. van Domburg Jeroen J. Bax Harm H. H. Feringa Peter G. Noordzij Olaf Schouten Don Poldermans 《Journal of nuclear cardiology》2007,14(4):550-554
Background Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiac death. Data on the prognostic value of
myocardial perfusion imaging (MPI) in patients with LVH are limited. The aim of this study is to assess the independent value
of stress technetium 99m tetrofosmin MPI in predicting the long-term mortality rate in patients with LVH.
Methods and Results We studied 177 patients (mean age, 59±12 years; 134 men) with LVH by electrocardiographic criteria who underwent dobutamine
or exercise stress Tc-99m tetrofosmin MPI. Endpoints during follow-up were cardiac and all-cause death and hard cardiac events.
A normal scan was detected in 42 patients (24%). Myocardial perfusion abnormalities were fixed in 59 patients (33%) and reversible
in 76 (43%). Perfusion abnormalities were observed in a single-vessel distribution in 79 patients and in a multivessel distribution
in 56. During a mean follow-up period of 5.5±2 years, 60 patients (34%) died. Death was considered cardiac in 42 patients
(24%). Nonfatal myocardial infarction occurred in 10 patients (6%). The annual mortality rate was 1.4% in patients with normal
perfusion, 3.2% in those with perfusion abnormalities in a single-vessel distribution, and 8% in those with a multivessel
distribution. In a multivariate analysis independent predictors of death were age (risk ratio [RR], 1.05; 95% confidence interval
[CI], 1.02–1.07), male gender (RR, 1.9; 95% CI, 1.1–3.6), hypercholesterolemia (RR, 1.7; 95% CI, 1.0–2.9), and abnormal perfusion
(RR, 2.7; 95% CI, 1.5–4.8).
Conclusion In patients referred for stress MPI, LVH is associated with a high mortality rale, with approximately one third of patients
dying over a period of 5 years. Stress Tc-99m tetrofosmin MPI provides independent information for predicting death in these
patients.
This study was supported in part by a limited publication grant from GE Healtheare. 相似文献
3.
George M. Segall Carole Stepp Prajoy P. Kadkade Michael W. Dae Elias H. Botvinick 《Journal of nuclear cardiology》1997,4(5):358-363
Background Shortening the acquisition time for myocardial single-photon emission computed tomographic (SPECT) imaging increases patient
comfort and laboratory throughput. The purpose of this study was to compare the diagnostic accuracy for coronary artery disease
detection of myocardial SPECT images acquired in 5 to 10 minutes versus 25 minutes using Tc-99m methoxyisobutylisonitrile
(Tc-99m sestamibi) and a single-head gamma camera.
Methods and Results Forty-one subjects had a standard 1-day rest/stress Tc-99m sestamibi myocardial SPECT study. Two sets of rest and stress images
were acquired on the same day for each subject. One set of images was acquired with a 5- to 10-minute fast acquisition protocol;
the second set of images was acquired with a 25-minute standard protocol. The accuracies of the fast and standard protocols
for identifying individuals with and without coronary artery disease were equivalent. Accuracy was 76% for the fast protocol
and 73% for the standard protocol in individuals with at least one coronary stenosis ≥70%. The accuracies of the two protocols
for identifying individual coronary arteries with stenoses ≥70% also were equivalent. Accuracy was 77% for the fast protocol
and 74% for the standard protocol.
Conclusions SPECT myocardial images may be acquired in as little as 5 to 10 minutes using Tc-99m sestamibi and a 1-day rest/stress protocol.
Accuracy is equivalent to that attained in studies with longer imaging time. 相似文献
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5.
Pasquale Sullo Alberto Cuocolo Emanuele Nicolai Stefania Cardei Antonio Nappi Fiorenzo Squame Eugenio M. Covelli Leonardo Pace Marco Salvatore 《European journal of nuclear medicine and molecular imaging》1996,23(6):648-655
The aim of this study was to evaluate the accuracy of quantitative 1-day exercise-rest technetium-99m tetrofosmin tomography in the identification of patients with coronary artery disease (CAD) and in the detection of individual stenosed coronary vessels. Sixty-one patients with suspected CAD who underwent coronary angiography and 13 normal volunteers were studied. All patients were submitted to two i.v. injections of99mTc-tetrofosmin, one at peak exercise (370 MBq) and the other (1110 MBq) at rest 3 h after exercise (images 15–30 min after injection for both studies). All patients with CAD (0% luminal stenosis) (n=50) had an abnormal99mTc-tetrofosmin tomogram. Only one patient without significant coronary narrowing showed abnormal findings. Overall sensitivity, specificity and diagnostic accuracy in the detection of individual stenosed vessels were 77%, 93% and 85%, respectively. Sensitivity and diagnostic accuracy in the identification of individuals stenosed coronary vessels were significantly higher (P<0.05) in patients with single-vessel disease (n=21) than in those with multivessel disease (n=29). Sensitivity, specificity and accuracy for detecting individual diseased vessels were similar in patients without previous myocardial infarction (n=26) and in those with previous myocardial infarction (n=35). In myocardial territories related to non-infarcted areas (n=128), sensitivity and specificity in the detection of stenosed vessels were 70% and 95%, respectively. In infarcted areas (n=55), sensitivity and specificity in the detection of stenosed vessels were 85% (P=NS vs non-infarcted areas) and 75% (P<0.05 vs non-infarcted areas), respectively. Finally, sensitivity was significantly lower (P<0.05) in vascular territories supplied by vessels with moderate stenosis (50%–75%) than in those supplied by vessels with severe stenosis (>75%). The results of this study demonstrate that quantitative 1-day exercise-rest99mTc-tetrofosmin single-photon emission tomographic imaging is a suitable and accurate technique to identify patients with CAD and to detect individual stenosed coronary vessels. 相似文献
6.
心肌灌注显像(MPI)在冠心病的诊断、危险度分层及预后评价中扮演着越来越重要的角色,冠状动脉钙化积分(CACS)可协助对冠心病患者进行进一步的危险度分层,但两者有各自的局限性和不足。将两者联合应用可以相互弥补不足,为临床提供更多的信息。行SPECT/CT心肌灌注显像时,需进行衰减矫正CT(CTAC)扫描,若采用心电门控的呼气末屏气螺旋CT扫描,则在用于MPI衰减矫正的同时又可用于CACS测定,实现一站式检查,在减少患者辐射剂量的同时又可为临床提供更多的信息。笔者综述了CACS、MPI及两者联合应用的临床价值,并对一站式采集MPI与CACS的最新进展进行了综述。 相似文献
7.
Young-Seung Kim Jianjun Wang Alexis Broisat David K. Glover Shuang Liu 《Journal of nuclear cardiology》2008,15(4):535-546
Background. Technetium 99m-N-MPO ([Tc-99m-N(mpo)(PNP5)]+) is a cationic Tc-99m nitrido complex. The objective of this study is to evaluate its potential as a new radiotracer for
myocardial perfusion imaging.
Methods and Results. Biodistribution studies were performed in Sprague-Dawley rats and guinea pigs to compare the myocardial uptake and excretion
kinetics of Tc-99m-N-MPO from noncardiac organs, such as the liver and lungs, with those of the known cationic Tc-99m radiotracers:
Tc-99m-N-DBODC5 and Tc-99m-sestamibi. Planar imaging was performed in Sprague-Dawley rats to evaluate the utility of Tc-99m-N-MPO
as a myocardial perfusion imaging agent. Metabolism studies were carried out by use of both Sprague-Dawley rats and guinea
pigs. In general, the heart uptake of Tc-99m-N-MPO was between that of Tc-99msestamibi and Tc-99m-N-DBODC5 over the 2-hour
study period. However, the heart-liver ratio of Tc-99m-N-MPO (12.75±3.34) at 30 minutes after injection was more than twice
that of Tc-99m-N-DBODC5 (6.01±1.45) and approximately 4 times higher than that of Tc-99msestamibi (2.90±0.22). The heart uptake
and heart-liver ratio of Tc-99m-N-MPO and Tc-99m-sestamibi in guinea pigs were significantly lower than those obtained in
Sprague-Dawley rats. The metabolism studies demonstrated no detectable Tc-99m-N-MPO metabolites in the urine and feces samples
of the Sprague-Dawley rats at 120 minutes after injection. In guinea pigs no Tc-99m-N-MPO metabolites were detected in the
urine at 120 minutes, but only approximately 60% of Tc-99m-N-MPO remained intact in the feces samples. In contrast, there
was no intact Tc-99m-sestamibi detected in urine samples, and less than 15% of Tc-99m-sestamibi remained intact in the feces
samples. Planar imaging studies indicated that clinically useful images of the heart may be obtained as early as 15 minutes
after injection of Tc-99m-N-MPO.
Conclusion. The combination of favorable organ biodistribution and myocardial uptake with rapid liver clearance makes Tc-99m-N-MPO a
very promising myocardial perfusion radiotracer worthy of further evaluation in various preclinical animal models.
This work was supported, in part, by Purdue University and the following research grants: R01 CA115883 A2 (S.L.) from the
National Cancer Institute, BCTR0503947 (S.L.) from the Susan G. Komen Breast Cancer Foundation, AHA0555659Z (S.L.) from the
Greater Midwest Affiliate of the American Heart Association, R21 EB003419-02 (S.L.) from the National Institute of Biomedical
Imaging and Bioengineering, and R21 HL083961-01 from the National Heart, Lung, and Blood Institute. 相似文献
8.
Gianmauro Sacchetti Eugenio Inglese Angelo S Bongo Franco Aina Marco Brambilla Alberto Baroli Carmelo Cernigliaro Pierfranco Dellavesa Edgardo Pittaluga Marco Rudoni 《European journal of nuclear medicine and molecular imaging》1997,24(10):1230-1236
The aim of this study was to determine the diagnostic accuracy of technetium-99m tetrofosmin myocardial imaging for the localization
of coronary artery stenoses of different degrees of severity. Stress-rest single-photon emission tomography (SPET) was performed
on separate days in 80 patients (64 males, 16 females; mean age 61 years; 43 patients with previous myocardial infarction;
18 patients with pharmacological stress), within 6 months of coronary angiography. Scintigraphic images were blindly and independently
evaluated by three observers. Coronary stenosis was defined as a >50% narrowing in luminal diameter; severe stenosis was defined
as a proximal stenosis of >75% or a peripheral stenosis of >90%. Coronary angiography revealed normal coronary arteries or
insignificant coronary stenosis in 13 patients and significant coronary stenoses in 67 patients. The sensitivity and specificity
of 99mTc-tetrofosmin SPET in respect of severely stenosed vessels were, respectively, 80% and 65% for the left anterior descending
artery (LAD), 100% and 46% for the right coronary artery (RCA) and 58 and 78% for the left circumflex artery (LCx) territories.
Considering all the significantly stenosed vessels, a significant decrease in sensitivity was observed for LAD territories
(to 59%, P=0.05), and a nonsignificant decrease for RCA (88%) and LCx (47%) territories while specificity values remained essentially
unchanged. No significant changes in sensitivity or specificity were observed when regions with previous myocardial infarction
were excluded. In conclusion, the sensitivity of 99mTc-tetrofosmin SPET for the localization of individual stenosed vessels is only moderate when all significant stenoses are
considered, but the ability of this technique to predict the location of severe coronary artery stenoses seems satisfactory,
with the exception of the low specificity in respect of RCA territories.
Received 26 April and in revised form 7 June 1997 相似文献
9.
OBJECTIVE: Prone thallium-201 ((201)Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone (201)Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese patients. METHODS: Of the 104 consecutive patients who underwent (201)Tl stress myocardial perfusion SPECT to diagnose coronary artery disease, we evaluated 46 who underwent image acquisition in both the supine and prone positions, and coronary angiography within 3 months thereafter. Images were acquired in the routine supine position immediately following (201)Tl (111 MBq) injection and 4 h following early acquisition. Images were acquired in the prone position only during the early phase following supine acquisition. We evaluated the SPECT images of the inferior half segments of the left ventricle using a five-point defect scoring system. According to the coronary angiographic findings, we investigated the diagnostic accuracy of stress-rest supine, stress supine, stress prone, and combined supine-prone images. Reduced uptake in the stress supine image of the combined images was considered as attenuation when uptake was normal in the prone image. RESULTS: The sensitivity of the stress-rest supine, stress supine, stress prone, and stress-combined supine-prone images was 77%, 86%, 55%, and 55%, and the specificity was 71%, 54%, 79%, and 83%, respectively. Diagnostic accuracy was the highest in stress-rest supine images. CONCLUSIONS: Prone images tended to improve the specificity of detecting coronary artery disease in the inferior wall, but not diagnostic accuracy compared with stress-rest supine images because of decreased sensitivity. 相似文献
10.
Daniel S. Berman Xingping Kang Hidetaka Nishina Piotr J. Slomka Leslee J. Shaw Sean W. Hayes Ishac Cohen John D. Friedman James Gerlach Guido Germano 《Journal of nuclear cardiology》2006,13(2):191-201
BACKGROUND: The diagnostic value of gated myocardial perfusion single-photon emission computed tomography (MPS) with combined supine and prone acquisitions to detect coronary artery disease (CAD) in obese and nonobese patients has not been defined. METHODS AND RESULTS: We studied 1511 patients without prior myocardial infarction or coronary revascularization who either had coronary angiography within 3 months of MPS (n = 785) or had a low pretest likelihood of CAD (n = 726). All patients underwent rest thallium 201/gated exercise or adenosine stress technetium 99m sestamibi MPS in both the supine and prone positions. According to body mass index (BMI), patients were categorized as normal weight (BMI of 18.5-24.9 kg/m2), overweight (BMI of 25.0-29.9 kg/m2), or obese (BMI > or = 30.0 kg/m2). There were no significant differences in stress, fixed, or ischemic defects among patients in different weight categories. The sensitivity of MPS was 85%, 86%, and 89% for detecting patients with 50% or greater coronary stenosis and 89%, 91%, and 92% for detecting those with 70% or greater coronary stenosis in the normal-weight, overweight, and obese groups, respectively. Normalcy rates were nearly identical among the 3 weight groups (99%, 98%, and 99%, respectively). Multivariate logistic regression analysis further confirmed that BMI was a nonsignificant predictor for the detection of CAD. In a subset of 290 patients, automated quantitative MPS analysis confirmed that combined supine and prone MPS increased specificity (86%) in identifying CAD, without a significant reduction in sensitivity (83% for > or = 50% stenosis and 88% for > or = 70% stenosis). CONCLUSION: The findings of this study suggest that MPS performed with gating and combined supine and prone acquisitions without attenuation correction had a similar diagnostic accuracy for the detection of CAD in normal-weight, overweight, and obese patients. 相似文献
11.
BACKGROUND: Increased lung uptake of thallium 201 during myocardial perfusion scintigraphy is related to severe coronary artery disease (CAD), but a similar relationship for technetium 99m sestamibi has not been clearly established. METHODS AND RESULTS: Resting and stress lung-heart ratios (LHR) were retrospectively determined in 96 patients who underwent Tc-99m sestamibi stress testing and coronary angiography within 4 months of each other. A semiquantitative CAD severity score (CADSS) was derived from the coronary angiogram. Left ventricular (LV) function was assessed in a subgroup of 42 subjects. CADSS of 24 or higher was associated with increased stress LHR compared with angiographically normal individuals (P =.009). Patients with severely impaired LV function also had a higher mean stress LHR than those with normal LV function (P =.01). Stress LHR was significantly greater than resting LHR in patients with coronary disease (0.32 +/- 0.07 vs 0.30 +/- 0.07; P =.003) and impaired LV function (0.35 +/- 0.08 vs 0.31 +/- 0.07; P <.02). CADSS correlated with stress, but not resting, LHR (P =.006), whereas the degree of LV dysfunction correlated with both resting (P =.046) and stress (P =.004) LHR. Left anterior descending (P =.017) and left main (P =.03) stenoses were independent predictors of increased stress LHR. CONCLUSIONS: An increase in stress Tc-99m sestamibi lung uptake is a marker for severe CAD. Correlation of stress LHR, but not resting LHR, with CAD severity supports exercise-induced pulmonary congestion as the underlying mechanism. 相似文献
12.
慢性稳定型冠心病的核素心肌灌注显像临床应用进展 总被引:1,自引:0,他引:1
李殿富 《国际放射医学核医学杂志》2004,28(3):97-100
多项临床试验证明,核素心肌灌注显像在冠心病诊断、危险度分层、预后判断、病人处理方案等方面具有突出的作用和优越的价值。在ACC/AHA(美国心脏病学院/美国心脏学会)有关冠心病和核心脏病学指南中,心肌灌注显像的上述作用得到了充分肯定。合理应用该项技术可以提高对冠心病诊断、处理的整体水平,并使有限的医疗资源得到更合理利用,这在我国目前显得十分迫切和需要。 相似文献
13.
Meyer C Strach K Thomas D Litt H Nähle CP Tiemann K Schwenger U Schild HH Sommer T 《European radiology》2008,18(2):226-233
To implement a high-resolution first-pass myocardial perfusion imaging protocol (HRPI) at 3 T, and to evaluate the feasibility,
image quality and accuracy of this approach prospectively in patients with suspected CAD. We hypothesized that utilizing the
gain in SNR at 3 T to increase spatial resolution would reduce partial volume effects and subendocardial dark rim artifacts
in comparison to 1.5 T. HRPI studies were performed on 60 patients using a segmented k-space gradient echo sequence (in plane
resolution 1.97 × 1.94 mm2). Semiquantitative assessment of dark rim artifacts was performed for the stress studies on a slice-by-slice basis. Qualitative
visual analysis was compared to quantitative coronary angiography (QCA) results; hemodynamically significant CAD was defined
as stenosis ≥70% at QCA. Dark rim artifacts appeared in 108 of 180 slices (average extent 1.3 ± 1.2 mm representing 11.8 ± 10.8%
of the transmural myocardial thickness). Sensitivity, specifity, and test accuracy for the detection of significant CAD were
89%,79%, and 85%. HRPI studies at 3 T are feasible in a clinical setting, providing good image quality and high accuracy for
detection of significant CAD. The presence of dark rim artifacts does not appear to represent a diagnostic problem when using
a HRPI approach. 相似文献
14.
Jeanine E. Roeters van Lennep Judocus J. J. Borm Aeilko H. Zwinderman Ernest K. J. Pauwels Albert V. G. Bruschke Ernst E. van der Wall 《Journal of nuclear cardiology》1999,6(6):596-604
BACKGROUND: Several studies have shown that the application of diagnostic and invasive procedures varies between men and women. The purpose of this study was to assess if referral for coronary angiography after technetium-99m tetrofosmin myocardial perfusion scintigraphy in 616 patients with undiagnosed chest pain might demonstrate gender bias. METHODS AND RESULTS: The primary end point for this study was coronary angiography within 90 days of myocardial perfusion scintigraphy. Women had more normal perfusion images than men (207 [70.9%] vs 160 [50.5%], P < .05). Of 242 patients with abnormal images (157 men, 85 women), 28 men (17.7%) and 17 women (20.0%) were referred for further invasive testing (P = not significant). Referral for coronary angiography increased relative to the number of defects. Univariate analysis showed that reversible and persistent defects were the most predictive variables for referral to coronary angiography (odds ratio [OR] 5.45, 95% confidence interval [CI] 3.10-9.58, P < .001, and OR 2.67, 95% CI 1.52-4.67, P = .001, respectively). More importantly, multivariate analysis showed that reversible perfusion defects (OR 4.77, 95% CI 2.48-9.17, P < .001) and persistent perfusion defects (OR 2.14, 95% CI 1.11-4.14, P = .02) were predictive of subsequent coronary angiography. No significant association between gender and subsequent coronary angiography was found both in univariate and multivariate logistic regression analysis (OR 0.64, 95% CI 0.37-1.12, P = .12, and OR 0.70, 95% CI 0.36-1.36, P = .28, respectively). CONCLUSIONS: Our study reveals that after correction for the presence and the severity of myocardial perfusion abnormalities, men and women were referred to coronary angiography at a similar rate. Thus, based on the results of technetium-99m tetrofosmin myocardial perfusion imaging, no substantial evidence for a gender-related bias could be found in the referral for further invasive testing. 相似文献
15.
Salvatore Azzarelli Alfredo R. Galassi Rosario Foti Carmelo Mammana Salvatore Musumeci Giuseppe Giuffrida Corrado Tamburino 《Journal of nuclear cardiology》1999,6(2):183-189
BACKGROUND: Technetium 99m-labeled myocardial agents have been proposed as an alternative to thallium 201. The aim of this study was to assess retrospectively the accuracy of exercise myocardial 99mTc-tetrofosmin scintigraphy with tomographic imaging (SPECT) in a large group population in the evaluation of coronary artery disease. Furthermore we evaluated the relation between the severity of scintigraphic impaired myocardial perfusion and the angiographic coronary artery stenoses in patients without myocardial infarction and with stenosis localized exclusively in the proximal segment of the 3 main coronary arteries. METHODS AND RESULTS: The study group consisted of 235 consecutive patients, 204 (87%) of whom were men, with a mean age of 57+/-10 years, and with suspected or known coronary artery disease, who underwent 99mTc-tetrofosmin SPECT and coronary angiography. Furthermore, 61 patients in a low-likelihood group for coronary artery disease were also studied. Significant disease was defined by > or = 50% luminal coronary artery stenosis in > or = 1 native coronary artery or major branch or in a saphenous vein graft or arterial mammary graft. The overall sensitivity was 95%, specificity was 76%, and predictive accuracy was 95%. The normalcy rate for the low-likelihood group was 93%. Sensitivity was 71% for the left anterior descending artery, 61% for the left circumflex artery, and 73% for the right coronary artery. Specificity was 94% for the left anterior descending artery, 96% for the left circumflex artery, and 91% for the right coronary artery. Predictive accuracy was 79% for the left anterior descending artery, 78% for the left circumflex artery, and 81 % for the right coronary artery. In patients without myocardial infarction linear regression analysis between scintigraphy and angiography showed a significant correlation in patients with severe proximal coronary artery stenosis (r = 0.53, P < .002), but not in those with moderate proximal stenosis (r = 0.31, P = NS). CONCLUSIONS: This study shows that 99mTc-tetrofosmin SPECT is accurate in the detection of coronary artery disease. The relation of the severity of scintigraphic impaired myocardial perfusion and angiographic coronary artery stenosis, however, may differ significantly in patients with proximal stenosis of different severity. 相似文献
16.
Shigeru Fukuzawa Shun Ozawa Masayuki Inagaki Toshihiro Inoue Shigeru Morooka Juji Sugioka 《Annals of nuclear medicine》1996,10(2):231-235
Tc-99m tetrofosmin is a lipophilic, cationic perfusion imaging agent that changes to Tl-201 in detecting coronary artery disease during exercise testing. The purpose of this study is to evaluate the usefulness of Tc-99m tetrofosmin dipyridamole stress imaging combined with low level exercise for the detection of coronary artery disease. We examined 42 patients and 10 normal volunteers who also underwent coronary angiography. A one-day protocol was used: in the stress study, 296 MBq of tetrofosmin was injected and in the rest study 888 MBq was injected. After intravenous administration of dipyridamole (0.142 mg/kg/min for 4 minutes), the patient was exercised on a bicycle ergometer for 3 min (25 Watts). Tetrofosmin was injected 2 minutes after dipyridamole infusion during the exercise. Single photon emission computed tomographic images were obtained 30 minutes after the tracer injection. Images were interpreted as abnormal in 36 of 42 patients with coronary artery disease, and normal in all of 10 normal volunteers. The overall sensitivity of detection of coronary artery disease was 83.3% and the normalcy rate was 100%. The diagnostic values for the detection of significant stenosis in the three major arteries were: LAD sensitivity 83%, specificity 92%; LCX sensitivity 47%, specificity 91%; RCA sensitivity 75%, specificity 83%. Of the 66 arteries with more than 50% stenosis, 48 arteries were correctly identified. Of the 36 with more than 70% stenosis, 31 were identified. Scintigraphic evidence of multivessel disease was found in only 9 patients (50%). A protocol of Tc-99m tetrofosmin SPECT combined with low level exercise after dipyridamole is therefore useful for the detection of the coronary artery disease. 相似文献
17.
BACKGROUND: Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach. METHODS AND RESULTS: We reviewed 200 consecutive patients without known CAD who were referred for CAC scoring shortly after nonischemic MPI. Of these, 13 (6.5%) had CAC scores greater than 400, indicating significant CAD; 22 (11%) had CAC scores of 101 to 400; 27 had CAC scores of 11 to 100; and the remainder (n = 138) has CAC scores of 1 to 10. Traditional risk factors and patient characteristics were not significant predictors of CAC scores of 101 or greater. However, age and the Framingham risk score were predictors of CAC scores greater than 0. At follow-up, significantly more patients with CAC scores of 101 or greater had been given the advice to take lipid-lowering medication and aspirin compared with those with CAC scores of 0. CONCLUSIONS: Of patients referred for CAC scoring after nonischemic MPI, 17.5% were identified as having CAD based on a CAC score greater than 100, allowing intervention with aggressive medical therapy. Patients who were reclassified were not easily identifiable by traditional risk factors, but Framingham risk score did predict the presence of CAC. Clinicians modified medical therapy based on the results of CAC scoring. 相似文献
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James A. Arrighi Matthew Burg Ira S. Cohen Robert Soufer 《Journal of nuclear cardiology》2003,10(3):267-274
BACKGROUND: Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS.Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS. CONCLUSIONS: These data indicate the feasibility of simultaneous assessment of perfusion and function responses during MS. Flow and function responses to MS are frequently not concordant. These data suggest that MS-induced changes in perfusion may represent a different phenomenon than MS-induced changes in left ventricular function (either globally or regionally). 相似文献