Original Articles 27 1 1997 관상동맥질환에서 Adenosine 부하 Tc-99m Abstract Tetrofosmin SPECT 의진단적유용성 * 황진용 이재태 ** 최지용 안병철 ** 조용근채성철 전재은 박의현 이규보 ** 김윤년 조인호 Evaluation of Coronary Artery Disease with Tc-99m Tetrofosmin SPECT in Conjuction with Intravenous Adenosine Jin Yong Hwang, M.D., Jaetae Lee, M.D.,** Ji Yong Choi, M.D., Byeong Cheol Ahn, M.D.,** Yong Keun Cho, M.D., Shung Chull Chae, M.D., Jae Eun Jun, M.D., Wee Hyun Park, M.D., Kyu Bo Lee, M.D.** Department of Internal Medicine and Nuclear Medicine,** School of Medicine, Kyungpook National University, Taegu, Korea Yoon Nyun Kim, M.D. Department of Internal Medicine, School of Medicine, Keimyung University, Taegu, Korea In Ho Cho, M.D. Department of Nuclear Medicine, School of Medicine, Youngnam University, Taegu, Korea BackgroundTc-99m tetrofosmin is a recently developed myocardial perfusion agent that has shown promising characteristics, displaying rapid accumulation in and slow clearance from the myocardium with rapid clearance from background organs. Adenosine is relatively safe, direct and potent coronary vasodilator and has been used as a stress agent in myocardial perfusion scintigraphy. We have performed tetrofosmin single photon emission computed tomographyspect in patients suspected of coronary artery disease. This study was aimed to assess the safety profile and diagnostic accuracy of adenosine Tc-99m tetrofosmin SPECT. MethodOne hundred forty six patients underwent Tc-99m tetrofosmin SPECT with intravenous adenosine. Four hours after resting Tc-99m tetrofosmin SPECT imaging, adenosine was infused 30
intravenously at a dose of 0.14 mgkg of body weight per minute for 6 min and Tc-99m tetrofosmin was injected at 3 min after start of infusion. Blood pressure, heart rate and side effects was recorded during and after four minutes of adenosine infusion. Forty seven of patients underwent coronary angiography within 2 weeks. ResultsAdenosine induced a significant and mild decrease in systolic and diastolic blood pressure at 2 min after start of adenosine infusion and a significant and mild increase in heart rate after 1 min of infusion which was normalized after completion of infusion. Side effects were observed in 70% of 146 patients. Chest discomfort30%, mild dyspea25%, chest pain19%, and headach12% were common. No serious side effects were observed despite of continuation of infusion. Adenosine infusion was terminated prematurely in 2 patients due to intolerable chest pain and restlessness, respectively. The diagnostic sensitivity for detection of CAD50% and 70% coronary stenosis by coronary angiography by adenosine Tc-99m tetrofosmin SPECT were sensitivity 92%, 97%, and specificity 91%, 86%, and predictive accuracy 91%, 94%, respectively. The sensitivities for detection of individual coronary stenosis50% and 70% coronary stenosis by coronary angiography were 76%, 79% for LAD, 67%, 67% for LCX, and 73%, 82% for RCA, respectively. Specificities were 92%, 89% for LAD, 100%, 100% for LCX, 92%, and 87% for RCA. ConclusionAdenosine Tc-99m tetrofosmin SPECT appears to be a feasible, safe, highly sensitive and specific test for the diagnosis of coronary artery disease. KEY WORDSTc-99m tetrofosmin SPECT Coronary artery disease Adenosine. 서 론 Fig. 1. Molecular structure of tetrofosmin1,2-bisbis2- ethoxy-ethylphosphino]ethane. 31
대상및방법 1. 연구대상 2. 검사방법 (Study Protocol) Table 1. Characteristics of subjects in the 44 patients Ageyears 5611 MaleFemale 31166634 History of MI 1636.4 No. of stenotic artery Stenosis 50% Stenosis 70% No 1123 1226 1VD 1634 2145 2VD 1634 1123 3VD 4 9 3 6 Values in parentheses are percentage VDvessel disease Fig. 2. Same day Tc 99m tetrofosmin SPECT imaging. 32
4. 관상동맥조영술및판정 5. 통계 3. Tc-99m 심근 SPECT영상및판정 결과 1. 관상동맥조영술소견 Table 2. Hemodynamic effects of adenosine in the 146 patients Baseline Peak effect p Value Heart ratebeatmin 71 12 79 16 P0.001 Systolic BPmmHg 133 25 127 25 p0.01 Diastolic BPmmHg 79 13 72 13 p0.001 Rate-pressure product 9.5 2.7 10.5 3.6 p0.001 Values are meansstandard deviations BPblood pressure, rate-pressure productbeatesmin mmhg103 33
2. Adenosine 정주에따른혈역학의변화 3. Adenosine 정주에따른부작용 Table 3. Side effectsn146 Side effects Chest discomofort Dyspnea Chest pain Headache Neck discomfort Facial flushing Palpitationv Nausea Dizzness Premature termination No side effects No. of patients%) 4330 3725 2819 1812 1712 12 8 3 2 2 1 1 1 2 1 4934 4. Adenosine 부하 Tc-99m tetrofosmin SP- ECT 검사의관동맥질환진단능 Table 4. Diagnostic values in the detection of CAD Stenosis50% Stenosis70% Sensitivity 923336 973233 Specificity 911011 861214 PV 973334 943234 PV 771013 921213 PA 914347 944447 Values in parenthesis are no. of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 34
Fig. 3. 근위좌전하행지 Proximal anterior descending artery에 90% 협착이있었던남자 52세협심증환자의 adenosine 부하 Tc-99m tetrofosmin SPECT 소견. Table 5. Diagnostic accuracy for the detection of individual stenotic artery Stenosis50% Stenosis70% Sensitivity% 72 42 58 7639 51 Specificity% 95 79 83 92 83 90 )PV%) 91 42 46 85 39 46 )PV%) 83 79 95 87 83 95 PA%) 86121141 87121140 Values in parenthesis are no. of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 5. Adenosine 부하 Tc-99m tetrofosmin SPECT 검사의개개관동맥분지별협착발견의진단능 35
Table 6. Diagnostic values in localizing stenotic artery LAD LCX RCA 50% 70% 50% 70% 50% 70% Sensitivity 761621 791519 671015 671015 731622 821417 Specificity 922426 892528 1003232 1003232 922325 872630 PV 891618 831518 1001010 1001010 891618 781418 PV 832429 862529 863237 863237 792329 902629 PA 854047 854047 894247 894247 833947 854047 LAD left anterior descending artery LCX left circumflex artery RCA right coronary artery Values in parenthesis are numbers of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 고찰 36
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요약 연구배경 : 38
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