平面心肌灌注成像评价急性胸痛患者的价值

作     者：Yamada A.T. Soares Jr. J. Meneghetti J.C. 郝广华 

作者机构：Heart Institute (InCor) Univ. of S. Paulo Medical School Av. Dr. Eneas Carvalho A. S. ao Paulo Brazil 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第5期

页      面：44-45页

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 08[工学] 1010[医学-医学技术（可授医学、理学学位）] 10[医学] 

主　　题：急性胸痛 灌注成像 灌注缺损 心脏事件 急性心肌缺血 急诊科 阴性预测值 门控 检查费用 风险度 

摘      要：Background: Rest single-photon emission computed tomographic(SPECT) perfusion imaging identifies acute myocardial ischemia in patients with chest pain in the emergency department; however, the costs are high and radioisotopic services are usually not available 24 h a day. Planar imaging through a portable gamma camera may be useful in this setting. However, planar imaging might be associated with less predictive values in comparison with a gated SPECT imaging. We sought to evaluate rest planar myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia. Methods: Patients within 6 h of chest pain onset and nondiagnostic electrocardiograms(ECGs) underwent planar myocardial perfusion imaging. Studies showing perfusion defects were considered suggestive of acute coronary syndromes. The results of planar scintigraphy were compared with the clinical diagnosis and outcomes. All patients were followed up and monitored for the occurrence of major cardiac events 120 days after hospital discharge. Results: 71 patients underwent scintigraphy. Twenty-one(30%) patients had acute coronary syndromes, 15(21%) had major cardiac events(8 had myocardial infarction and 7 underwent myocardial revascularization). Planar scintigraphy demonstrated perfusion defects in 21 patients, 16 (76%) patients with acute coronary syndromes, 12(80%) patients who had major cardiac events and in 7(88%) patients with myocardial infarction. The negative predictive value of planar scintigraphy was 90%for diagnosis of acute coronary syndromes and 94%for detecting major cardiac events. Conclusion: Early planar myocardial perfusion imaging allowed rapid and accurate risk stratification of emergency departments patients with possible myocardial ischemia and nondiagnostic ECGs.