Preoperative comparison of different noninvasive strategies for predicting improvement in left ventricular function after coronary artery bypass grafting

被引:23
作者
Bax, JJ
Maddahi, J
Poldermans, D
Elhendy, A
Schinkel, A
Boersma, E
Valkema, R
Krenning, EP
Roelandt, JRTC
van der Wall, EE
机构
[1] Univ Leiden Hosp, Dept Cardiol, NL-2333 ZA Leiden, Netherlands
[2] Univ Calif Los Angeles, Sch Med, Dept Mol & Med Pharmacol Nucl Med, Los Angeles, CA USA
[3] Thorax Ctr Rotterdam, Dept Cardiol, Rotterdam, Netherlands
[4] Thorax Ctr Rotterdam, Dept Clin Epidemiol Biostat, Rotterdam, Netherlands
关键词
D O I
10.1016/S0002-9149(03)00454-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Thallium-201 (Tl-201) imaging and dobutamine stress echocardiography (DSE) are the most frequently used tests in the clinical setting for assessing viability. However, Tl-201 has a suboptimal specificity and DSE a suboptimal sensitivity to predict functional improvement after revascularization. F18-fluorodeoxyglucose (FDG) imaging is considered highly accurate, but availability is limited. Sequential imaging of Tl-201 and DSE may improve accuracy for assessing viability and may be comparable to FDG. Forty-seven patients with ischemic cardiomyopathy underwent Tl-201 single-photon emission computed tomography (SPECT) at rest (4-hour delayed imaging), DSE, and FDG SPECT before bypass surgery. Sensitivity, specificity, and accuracy of 2 sequential strategies were compared with those of FDG SPECT. Strategy I considered Tl-201 imaging as the first step, followed by DSE in patients with an intermediate likelihood of viability on Tl-201. Strategy 2 considered DSE as the first step, followed by Tl-201 imaging. Left ventricular ejection fraction was assessed before and 6 months after revascularization, and improvement of greater than or equal to5% was considered significant. Tl-201 had a high sensitivity (95%, p <0.05 vs DSE) with a low specificity (57%, p <0.05 vs DSE). DSE had a low sensitivity (63%, p <0.05 vs Tl-201) with a high specificity (89%, p <0.05 vs Tl-201). Both strategies 1 and 2 resulted in high sensitivities (891% and 89%, respectively) and high specificities (89% and 86%, respectively), compared with FDG SPECT (sensitivity 89%, specificity 86%). Sequential testing by Tl-201 SPECT and DSE has a comparable accuracy to FDG SPECT to predict improvement in left ventricular ejection fraction after revascularization. In centers without access to FDG, sequential imaging with Tl-201 and DSE offers an accurate alternative for assessing myocardial viability. (C)2003 by Excerpta Medica, Inc.
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页码:1 / 4
页数:4
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